Provider Demographics
NPI:1194757294
Name:GOTTHELF, MICHAEL EDWAD I (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWAD
Last Name:GOTTHELF
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MEMORIAL DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2238
Mailing Address - Country:US
Mailing Address - Phone:978-537-3355
Mailing Address - Fax:978-537-9211
Practice Address - Street 1:50 MEMORIAL DR
Practice Address - Street 2:SUITE 211
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2238
Practice Address - Country:US
Practice Address - Phone:978-537-3355
Practice Address - Fax:978-537-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA344822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA034482Medicaid
MAB33401Medicare ID - Type UnspecifiedMR #