MEDICARE: DR. NEIL BRUCE GOTTLIEB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	MD072671L	PA

General Provider Information

NPI Number	:	1649250382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL BRUCE GOTTLIEB M.D.

Provider Business Mailing Address
First Line	:	8100 ROOSEVELT BLVD
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2900
Country	:	US
Telephone Number	:	215-335-5355
Fax Number	:	215-335-5352

Provider Business Practice Location Address
First Line	:	2137 WELSH RD
Second Line	:	SUITE 2D
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-4963
Country	:	US
Telephone Number	:	215-698-7333
Fax Number	:	215-673-9492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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