Provider Demographics
NPI:1952322844
Name:GOTTESMAN, CHERYL S (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STURDY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3152
Mailing Address - Country:US
Mailing Address - Phone:508-236-8370
Mailing Address - Fax:508-236-8377
Practice Address - Street 1:19 STURDY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3152
Practice Address - Country:US
Practice Address - Phone:508-236-8370
Practice Address - Fax:508-236-8377
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0402010OtherUHC
000000028113OtherBMC HEALTHNET
60344OtherHPHC
339OtherFALLON
B10054201OtherCIGNA
MAJ11602OtherMABC
074963OtherTUFTS
MA3093808Medicaid
202197OtherRIBCHIP
B10054201OtherCIGNA
MAJ11602Medicare ID - Type Unspecified