Provider Demographics
NPI:1659868701
Name:GOBOURNE, ASIA CORDELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIA
Middle Name:CORDELIA
Last Name:GOBOURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:156 WILLIAM ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5358
Mailing Address - Country:US
Mailing Address - Phone:646-962-5665
Mailing Address - Fax:646-962-5687
Practice Address - Street 1:156 WILLIAM ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5358
Practice Address - Country:US
Practice Address - Phone:646-962-5665
Practice Address - Fax:646-962-5687
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312618207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist