Healthcare Provider Details

I. General information

NPI: 1407813124
Provider Name (Legal Business Name): DANIEL J. GOTTLIEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
BOSTON MA
02132-4927
US

IV. Provider business mailing address

35 PLOWGATE RD
CHESTNUT HILL MA
02467-3722
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number71907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: