Provider Demographics
NPI:1720033244
Name:GOLTZ, GERALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
Last Name:GOLTZ
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 1:701 BROAD ST
Mailing Address - Street 2:
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:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1498
Practice Address - Country:US
Practice Address - Phone:412-741-2552
Practice Address - Fax:412-741-9339
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-015354-E207RE0101X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00753272Medicaid
PA091252OtherKEYSTONE HEALTH PLAN WEST
PA23532OtherHEALTHAMERICA
PA73313OtherMEDPLUS
PA00753272Medicaid
PA23532OtherHEALTHAMERICA