Provider Demographics
NPI:1215261318
Name:MILES, CARLOTTA GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOTTA
Middle Name:GORDON
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CONNECTICUT AVE, NW
Mailing Address - Street 2:#206
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008
Mailing Address - Country:US
Mailing Address - Phone:202-462-0770
Mailing Address - Fax:202-291-8535
Practice Address - Street 1:3000 CONNECTICUT AVE, NW
Practice Address - Street 2:#206
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:202-462-0770
Practice Address - Fax:202-291-8535
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCM.D.25398102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst