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NPI Code Detail

MEDICARE: DIANE GOTTLIEB MD

MEDICARE: DIANE GOTTLIEB MD
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
12084P0800XPsychiatry PhysicianMD064466LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124017082
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE GOTTLIEB MD
Provider Business Mailing Address
First Line : 2900 W QUEEN LN
Second Line : SUITE 221H
City : PHILADELPHIA
State : PA
Zip : 19129-1033
Country : US
Telephone Number : 215-991-8532
Fax Number : 215-843-5495
Provider Business Practice Location Address
First Line : 2900 W QUEEN LN
Second Line : SUITE 221H
City : PHILADELPHIA
State : PA
Zip : 19129-1033
Country : US
Telephone Number : 215-991-8532
Fax Number : 215-843-5495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 05/14/2008

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