Provider Demographics
NPI:1477556793
Name:GOTTLIEB, SIDNEY O (MD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:O
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:STE 150LL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-602-9262
Mailing Address - Fax:410-602-9276
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:STE 600
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5807
Practice Address - Country:US
Practice Address - Phone:410-825-5150
Practice Address - Fax:410-296-0809
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0026488207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76241Medicare UPIN
MD000L003AMedicare ID - Type Unspecified