Healthcare Provider Details

I. General information

NPI: 1831136530
Provider Name (Legal Business Name): ROBERT H GOTTLIEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 WORCESTER RD SOUTHBORO MEDICAL
FRAMINGHAM MA
01701-5224
US

IV. Provider business mailing address

761 WORCESTER RD SOUTHBORO MED. OF FRAMINGHAM
FRAMINGHAM MA
01701-5224
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-1107
  • Fax:
Mailing address:
  • Phone: 508-872-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number73523
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: