Provider Demographics
NPI:1801903711
Name:GOELTSCH, ROBERT EDUARD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDUARD
Last Name:GOELTSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1821 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-1522
Mailing Address - Country:US
Mailing Address - Phone:717-230-3906
Mailing Address - Fax:717-230-3914
Practice Address - Street 1:845 SIR THOMAS CT
Practice Address - Street 2:SUITE 8
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4840
Practice Address - Country:US
Practice Address - Phone:717-671-8747
Practice Address - Fax:717-671-8918
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014264E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0855951Medicaid
PA0855951Medicaid
PAB34558Medicare UPIN