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General NPI Number Information
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NPI Number | 1508055591
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Entity Type | Organization
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Legal Business Name | IRVING S GOTTFRIED MD PC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 800 OAK ST SUITE 2-105
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City | FARMVILLE
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State | VA
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Zip | 23901-1199
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Country | US
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Telephone | 434-392-6877
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Fax | 434-392-8809
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Provider Business Mailing Address
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Address Line | 800 OAK ST SUITE 2-105
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City | FARMVILLE
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State | VA
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Zip | 23901-1199
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Country | US
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Telephone | 434-392-6877
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Fax | 434-392-8809
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. IRVING SASS GOTTFRIED
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Credential | M.D.
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Telephone | 434-392-6877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101039536
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License Number State | VA
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