Provider Demographics
NPI:1629209200
Name:GOOTENBERG, JOSEPH ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ERIC
Last Name:GOOTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6915 BREEZEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4323
Mailing Address - Country:US
Mailing Address - Phone:301-881-0818
Mailing Address - Fax:301-881-0819
Practice Address - Street 1:6915 BREEZEWOOD TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4323
Practice Address - Country:US
Practice Address - Phone:301-881-0818
Practice Address - Fax:301-881-0819
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0027242208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics