Provider Demographics
NPI:1396720702
Name:GOTTESMAN, RITA (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
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 1:10 GUYENCOURT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-1416
Mailing Address - Country:US
Mailing Address - Phone:302-545-4990
Mailing Address - Fax:
Practice Address - Street 1:2055 LIMESTONE RD STE 104
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5536
Practice Address - Country:US
Practice Address - Phone:302-633-6200
Practice Address - Fax:302-575-9322
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00038612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000589201Medicaid
DE115946W26Medicare PIN
DE00A575G66Medicare PIN
DE003996D14Medicare PIN
DE115946B93Medicare PIN
DE0000589201Medicaid
DE000M72P97Medicare PIN
DEC04972Medicare UPIN