Provider Demographics
NPI:1174501977
Name:GOTTLIEB, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-3200
Mailing Address - Country:US
Mailing Address - Phone:717-544-3600
Mailing Address - Fax:717-544-3604
Practice Address - Street 1:2102 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604-3200
Practice Address - Country:US
Practice Address - Phone:717-544-3600
Practice Address - Fax:717-544-3604
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012483E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066459OtherHIGHMARK BLUE SHIELD
PA8369 4336OtherGEISINGER HEALTH PLAN
PAD68743OtherHEALTH ASSURANCE
PA4376108OtherAETNA NON-HMO
PA532427OtherAETNA HMO
PA1518930OtherGATEWAY HEALTH PLAN
PA0006798720002Medicaid
PA01490902OtherCAPITAL BLUE CROSS
PA8369 4336OtherGEISINGER HEALTH PLAN
PA066459OtherHIGHMARK BLUE SHIELD