MEDICARE: DR. IRA J GOTTLIEB D.P.M.

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
1	213E00000X	Podiatrist	00973	MD

Other Identifiers

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

General Provider Information

NPI Number	:	1265430524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA J GOTTLIEB D.P.M.

Provider Business Mailing Address
First Line	:	8030B RITCHIE HWY
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-1084
Country	:	US
Telephone Number	:	410-761-0118
Fax Number	:	410-761-5118

Provider Business Practice Location Address
First Line	:	8030B RITCHIE HWY
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-1084
Country	:	US
Telephone Number	:	410-761-0118
Fax Number	:	410-761-5118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/14/2024

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