Provider Demographics
NPI:1598967424
Name:GOSS, CARMEN NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:NICOLE
Last Name:GOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0549
Mailing Address - Country:US
Mailing Address - Phone:787-816-8798
Mailing Address - Fax:787-815-7560
Practice Address - Street 1:CALLE LUIS GANDIA #58
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-8798
Practice Address - Fax:787-815-7560
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR92592080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine