Provider Demographics
NPI:1710206842
Name:GERALD M. GOLTZ, M.D. & ASSOCIATES, PC
Entity Type:Organization
Organization Name:GERALD M. GOLTZ, M.D. & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:REITER-GOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:412-716-7793
Mailing Address - Street 1:701 BROAD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1652
Mailing Address - Country:US
Mailing Address - Phone:412-741-2552
Mailing Address - Fax:412-741-9339
Practice Address - Street 1:701 BROAD ST
Practice Address - Street 2:SUITE C
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1652
Practice Address - Country:US
Practice Address - Phone:412-741-2552
Practice Address - Fax:412-741-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015354E207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00753272Medicaid
PA00753272Medicaid