Provider Demographics
NPI:1598811259
Name:GOBERN, CARMITA ANTIONETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMITA
Middle Name:ANTIONETTE
Last Name:GOBERN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:110 IRVING STREET
Practice Address - Street 2:ROOM GB10
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-2444
Practice Address - Fax:202-877-7069
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-06-13
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Provider Licenses
StateLicense IDTaxonomies
MDD0054012207R00000X
DCMD31634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93961Medicare UPIN
010609M92Medicare ID - Type Unspecified