Provider Demographics
NPI:1326034158
Name:GOTTFRIED, IRVING SASS (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:SASS
Last Name:GOTTFRIED
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 1:3824 NORTHERN PIKE
Mailing Address - Street 2:STE 700
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2184
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:
Practice Address - Street 1:3824 NORTHERN PIKE
Practice Address - Street 2:STE 830
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2141
Practice Address - Country:US
Practice Address - Phone:412-457-0427
Practice Address - Fax:412-457-0429
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125223207RG0100X
VA0101039536207RG0100X
PAMD030329E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4670798OtherAETNA
253249OtherMAMSI/TRICARE
VA53907OtherSENTARA
VA6046258Medicaid
VA042514OtherANTHEM BC/BS
VA1000013150OtherMEDICARE RAILROAD
VA53907OtherSENTARA
VA53907OtherSENTARA