Provider Demographics
NPI:1225266018
Name:GOTTLIEB, EMILY MARA (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARA
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 1:5933 AVON DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2201
Mailing Address - Country:US
Mailing Address - Phone:202-431-1401
Mailing Address - Fax:
Practice Address - Street 1:19785 CRYSTAL ROCK DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-4700
Practice Address - Country:US
Practice Address - Phone:202-431-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057151207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology