Healthcare Provider Details

I. General information

NPI: 1437155991
Provider Name (Legal Business Name): GILBERT GOLIATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 MACCORKLE AVE SW STE 400
SOUTH CHARLESTON WV
25309-1364
US

IV. Provider business mailing address

1827 DEVONDALE CIR
CHARLESTON WV
25314-2205
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-3988
  • Fax: 304-766-3984
Mailing address:
  • Phone: 304-345-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15811
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: