Organization
IRVING S GOTTFRIED MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRVING SASS GOTTFRIED M.D. (OWNER/OPERATOR)
(434) 392-6877
Entity
Organization
Contact information
Practice address
800 OAK ST, SUITE 2-105, FARMVILLE, VA 23901-1199
(434) 392-6877
(434) 392-8809
Mailing address
800 OAK ST, SUITE 2-105, FARMVILLE, VA 23901-1199
(434) 392-6877
(434) 392-8809
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101039536
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042514
ANTHEM BC/BS
VA
01
—
1000013150
MEDICARE RAILROAD
VA
01
—
53907
SENTARA
VA
05
—
6046258
—
VA
Enumeration date
10/16/2007
Last updated
10/16/2007
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