Provider Demographics
NPI:1104868603
Name:GODIN, KAREN D (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:GODIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 UNION ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-8603
Mailing Address - Country:US
Mailing Address - Phone:207-973-8030
Mailing Address - Fax:
Practice Address - Street 1:915 UNION ST STE 4
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-8603
Practice Address - Country:US
Practice Address - Phone:207-973-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-739363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00396223OtherRAILROAD MEDICARE
MEP00396223OtherRAILROAD MEDICARE
H49382Medicare UPIN