Provider Demographics
NPI:1962447458
Name:GOTLIB, BERNARD NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:NORMAN
Last Name:GOTLIB
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 1:108 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1317
Mailing Address - Country:US
Mailing Address - Phone:413-732-1081
Mailing Address - Fax:
Practice Address - Street 1:108 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1317
Practice Address - Country:US
Practice Address - Phone:413-732-1081
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25883207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9746668Medicaid
MA9746668Medicaid