Provider Demographics
NPI:1700871084
Name:GOTFRIED, ROBERT S (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GOTFRIED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3939
Mailing Address - Fax:614-293-3912
Practice Address - Street 1:465 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8081
Practice Address - Country:US
Practice Address - Phone:614-293-3939
Practice Address - Fax:614-293-3912
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007065207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2120672Medicaid
E90205Medicare UPIN
OHG00884781Medicare ID - Type Unspecified