MEDICARE: DAVID LAWRENCE GOTTESMAN 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
1	207RG0100X	Gastroenterology Physician	35041960	OH

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	:	1770686651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LAWRENCE GOTTESMAN MD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	440-461-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 LANDERBROOK DR
Second Line	:	SUITE 190
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-4020
Country	:	US
Telephone Number	:	440-461-2550
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	06/27/2014

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