Provider Demographics
NPI:1508944570
Name:GODIN, WILLIS E (DO)
Entity type:Individual
Prefix:
First Name:WILLIS
Middle Name:E
Last Name:GODIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LARK LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-9529
Mailing Address - Country:US
Mailing Address - Phone:609-929-2899
Mailing Address - Fax:
Practice Address - Street 1:1697 CROWN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6310
Practice Address - Country:US
Practice Address - Phone:717-299-5000
Practice Address - Fax:717-431-4310
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07505500207RC0000X
TN3026207RC0000X
PAOS012471207RC0000X, 207UN0901X
NJMB07505500207RC0000X
VA0102204502207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I068217Medicare PIN
VAVVK770AMedicare PIN