Active NPI
Jerome Gottlieb, MD
- Psychiatry Physician
- Lancaster, PA
National Provider Identifier
1821024936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD032172E
- Practice address
- 555 N Duke St
Lancaster, PA 17602-2250 - Phone
- (717) 544-5511
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD032172E | PA | Primary |
Addresses
Primary practice location
555 N Duke St
Lancaster, PA 17602-2250
Mailing address
555 N Duke St
Lancaster, PA 17602-2250
Phone (717) 544-5511
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50055865 | Other | PA | CAPITAL BLUE CROSS |
| 3550126000 | Other | PA | INDEPENDENCE BLUE CROSS |
| 001518983 | Other | PA | CBHNP |
| 001518983 | Medicaid | PA | |
| 000405053 | Other | PA | HIGHMARK BLUE SHIELD |
| 246547000 | Other | PA | MAGELLAN |
| 1577264 | Other | PA | GATEWAY |
| P00003237 | Other | PA | RAILROAD MEDICARE |
| 1150002 | Other | PA | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD032172E | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254873600000",
"number": "1821024936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 N DUKE ST",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022250",
"telephone_number": "717-544-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 N DUKE ST",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022250",
"telephone_number": "717-544-5511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTLIEB",
"first_name": "JEROME",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2009-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD032172E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50055865",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENCE BLUE CROSS",
"identifier": "3550126000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CBHNP",
"identifier": "001518983",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001518983",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "000405053",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "246547000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY",
"identifier": "1577264",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00003237",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1150002",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.