MEDICARE: ROBERT D GOBER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	H0026622	MD

General Provider Information

NPI Number	:	1891000642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT D GOBER D.O.

Provider Business Mailing Address
First Line	:	1120 SAINT PAUL ST
Second Line	:	GROUND LEVEL
City	:	BALTIMORE
State	:	MD
Zip	:	21202-2618
Country	:	US
Telephone Number	:	410-908-0946
Fax Number	:	410-332-9988

Provider Business Practice Location Address
First Line	:	1120 SAINT PAUL ST
Second Line	:	GROUND LEVEL
City	:	BALTIMORE
State	:	MD
Zip	:	21202-2618
Country	:	US
Telephone Number	:	410-908-0946
Fax Number	:	410-332-9988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/17/2010

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