Provider Demographics
NPI:1548281918
Name:GOTTESMAN, MAX W (DO)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:W
Last Name:GOTTESMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1910 SASSAFRAS ST
Mailing Address - Street 2:BEHAVIORAL HEALTH UNIT
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:814-452-5490
Mailing Address - Fax:814-452-7610
Practice Address - Street 1:1910 SASSAFRAS ST
Practice Address - Street 2:BEHAVIORAL HEALTH UNIT
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2716
Practice Address - Country:US
Practice Address - Phone:814-452-5490
Practice Address - Fax:814-452-7610
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008331L2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70740Medicare UPIN