Individual
RICHARD P. GODDEAU JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF NEUROLOGY, WORCESTER, MA 01655-0002
(508) 334-2527
(508) 856-6778
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
14500
NH
2084N0400X
Neurology Physician
Primary
238478
MA
2084V0102X
Vascular Neurology Physician
238478
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016718
—
VT
05
—
110093404A
—
MA
05
—
30227618
—
NH
Enumeration date
01/16/2007
Last updated
12/16/2020
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