Provider Demographics
NPI:1881691715
Name:GOTTLIEB, SHELDON KENNETH (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:KENNETH
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2301
Mailing Address - Country:US
Mailing Address - Phone:202-333-1907
Mailing Address - Fax:202-338-0477
Practice Address - Street 1:900 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2301
Practice Address - Country:US
Practice Address - Phone:202-333-1907
Practice Address - Fax:202-338-0477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25652207N00000X
MDD0013967207N00000X
CAC310116207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110962Medicare ID - Type Unspecified
D18128Medicare UPIN