Provider Demographics
NPI:1962414433
Name:GOTTLIEB, STEVEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:GOTTLIEB
Suffix:
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:P.O. BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19723-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:2128 EMBASSY DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2385
Practice Address - Country:US
Practice Address - Phone:717-481-8771
Practice Address - Fax:717-481-9956
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058407L2084N0402X
PAMD058497L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG39180Medicare UPIN