Provider Demographics
NPI:1811155047
Name:GOTTWALD, ERICH LIN (DO)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:LIN
Last Name:GOTTWALD
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 1:1941 LIMESTONE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5413
Mailing Address - Country:US
Mailing Address - Phone:215-805-0671
Mailing Address - Fax:
Practice Address - Street 1:1941 LIMESTONE RD STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5413
Practice Address - Country:US
Practice Address - Phone:302-655-9494
Practice Address - Fax:302-691-1478
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016086208100000X
DEC7-0003989208D00000X
DEC2-0011980208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice