Provider Demographics
NPI:1437155991
Name:GOLIATH, GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:GOLIATH
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 1:1827 DEVONDALE CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2205
Mailing Address - Country:US
Mailing Address - Phone:304-345-4326
Mailing Address - Fax:
Practice Address - Street 1:4607 MACCORKLE AVE SW STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-766-3988
Practice Address - Fax:304-766-3984
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15811208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0106975000Medicaid
WV0106975000Medicaid