Provider Demographics
NPI:1356958235
Name:GATTLIEB, SAMUEL S
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:GATTLIEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 MARTINS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-5611
Mailing Address - Country:US
Mailing Address - Phone:304-984-0201
Mailing Address - Fax:
Practice Address - Street 1:2102 MARTINS BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-5611
Practice Address - Country:US
Practice Address - Phone:304-984-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant