Provider Demographics
NPI:1861187031
Name:GOETTEL, JAMES HEINRICH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HEINRICH
Last Name:GOETTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:64 MARLBOROUGH STREET W
Mailing Address - Street 2:
Mailing Address - City:LEAMINGTON
Mailing Address - State:ON
Mailing Address - Zip Code:N8H 1W1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 DEKALB PIKE, SUITE #202
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-275-7240
Practice Address - Fax:610-275-0633
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT228577208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty