Provider Demographics
NPI:1720033244
Name:GOLTZ, GERALD MARVIN (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MARVIN
Last Name:GOLTZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1652
Mailing Address - Country:US
Mailing Address - Phone:412-741-2552
Mailing Address - Fax:412-741-9339
Practice Address - Street 1:701 BROAD ST STE 421
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1670
Practice Address - Country:US
Practice Address - Phone:412-741-2552
Practice Address - Fax:412-741-9339
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-015354-E207RN0300X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091252OtherKEYSTONE HEALTH PLAN WEST
PA73313OtherMEDPLUS
PA00753272Medicaid
PA23532OtherHEALTHAMERICA
PA00753272Medicaid
PA23532OtherHEALTHAMERICA