Basic Information
Provider Information
NPI: 1558415570
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOSINE
FirstName: SHIVAN
MiddleName: RAJKUMAR
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: KAISER PERMANENTE MEDICARE ENROLLEMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber: 3018166308
Practice Location
Address1: 700 2ND STREET, NORTH EAST
Address2: CAPITOL HILL MEDICAL CENTER
City: WASHINGTON
State: DC
PostalCode: 20002
CountryCode: US
TelephoneNumber: 2023463000
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/23/2007
LastUpdateDate: 11/28/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XD0038521MDY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
207RG0100XMD15783DCN Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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