Provider Demographics
NPI:1164402806
Name:GOTTLIEB, HEATHER (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:102 PROGRESS DR STE 101
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2516
Practice Address - Country:US
Practice Address - Phone:215-230-0600
Practice Address - Fax:215-230-7065
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010671L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018998430006Medicaid
PA232691968OtherHEALTH PARTNERS
PA1398625OtherHIGHMARK BLUE SHIELD
PA30106260OtherKEYSTONE MERCY
PA2087245000OtherKEYSTONE IBC
PA8317389OtherAETNA
H62117Medicare UPIN
PA0018998430006Medicaid