Provider Demographics
NPI:1043447915
Name:GODDARD, ALLISON L (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:GODDARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:66 LEIGHTON RD # 2
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2225
Mailing Address - Country:US
Mailing Address - Phone:207-360-4214
Mailing Address - Fax:207-305-4196
Practice Address - Street 1:66 LEIGHTON RD # 2
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2225
Practice Address - Country:US
Practice Address - Phone:207-305-4196
Practice Address - Fax:207-360-4214
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036170500207N00000X
NH24018207N00000X
ME27373207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology