Provider Demographics
NPI:1588672265
Name:GOTTESMAN, ELEANOR J (MD, MPA)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:J
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:MD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 E 116TH ST
Mailing Address - Street 2:METROHEALTH BUCKEYE HEALTH CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2111
Mailing Address - Country:US
Mailing Address - Phone:216-957-4000
Mailing Address - Fax:
Practice Address - Street 1:2816 E 116TH ST
Practice Address - Street 2:METROHEALTH BUCKEYE HEALTH CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2111
Practice Address - Country:US
Practice Address - Phone:216-957-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350519272084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0826888Medicaid
OH3034625100OtherBWC
OH0826888Medicaid
OHGO7297091Medicare ID - Type Unspecified