Provider Demographics
NPI:1376736181
Name:GOSINE, VITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:VITRA
Middle Name:
Last Name:GOSINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VITRA
Other - Middle Name:
Other - Last Name:GOSINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17901 NW 5TH STREET
Mailing Address - Street 2:SUITE #103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029
Mailing Address - Country:US
Mailing Address - Phone:954-538-0022
Mailing Address - Fax:954-538-0028
Practice Address - Street 1:17901 NW 5TH STREET
Practice Address - Street 2:SUITE #103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:954-538-0022
Practice Address - Fax:954-538-0028
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99887207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK820YOtherMEDICARE PTAN