Provider Demographics
NPI:1649250382
Name:GOTTLIEB, NEIL BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:BRUCE
Last Name:GOTTLIEB
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2900
Mailing Address - Country:US
Mailing Address - Phone:215-335-5355
Mailing Address - Fax:215-335-5352
Practice Address - Street 1:2137 WELSH RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4963
Practice Address - Country:US
Practice Address - Phone:215-698-7333
Practice Address - Fax:215-673-9492
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD072671L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH64430Medicare UPIN