Provider Demographics
NPI:1831869312
Name:GOTTLOB, IRENE V (MD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:V
Last Name:GOTTLOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Mailing Address - Street 1:427 S CAMAC ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1140
Mailing Address - Country:US
Mailing Address - Phone:215-908-2012
Mailing Address - Fax:
Practice Address - Street 1:1 FEDERAL ST STE 200
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1088
Practice Address - Country:US
Practice Address - Phone:856-356-4924
Practice Address - Fax:856-356-4793
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10966900207WX0110X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist