Provider Demographics
NPI:1457440265
Name:GOTTLIEB, HYMAN DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:HYMAN
Middle Name:DAVID
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11733 LONE TREE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4310
Mailing Address - Country:US
Mailing Address - Phone:240-632-0998
Mailing Address - Fax:410-605-7919
Practice Address - Street 1:11733 LONE TREE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4310
Practice Address - Country:US
Practice Address - Phone:240-632-0998
Practice Address - Fax:410-605-7919
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC372213ES0103X
MD623213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418835Medicare PIN
DCT31202Medicare UPIN