Individual
DR. JONATHAN ELI GOTTLIEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6858
(410) 328-8664
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-6858
(410) 328-8664
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
D27968
MD
207RP1001X
Pulmonary Disease Physician
D27968
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305402101
—
MD
01
—
952931-01 & 02
BLUE CROSS/BLUE SHIELD
MD
01
—
S062-0363
BLUE CROSS/BLUE SHIELD - REGIONAL
MD
Enumeration date
02/19/2007
Last updated
02/26/2010
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