Provider Demographics
NPI:1922014372
Name:GODFREY, PETER EDWARD (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:EDWARD
Last Name:GODFREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 SUNSET LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3979
Mailing Address - Country:US
Mailing Address - Phone:540-825-4557
Mailing Address - Fax:540-825-4566
Practice Address - Street 1:541 SUNSET LN
Practice Address - Street 2:SUITE 301
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3979
Practice Address - Country:US
Practice Address - Phone:540-825-4557
Practice Address - Fax:540-825-4566
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035487207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B62289Medicare UPIN