1033130802 NPI number — MOHAMMED R GHEBA M.D.

Table of content: MOHAMMED R GHEBA M.D. (NPI 1033130802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033130802 NPI number — MOHAMMED R GHEBA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHEBA
Provider First Name:
MOHAMMED
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033130802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21042-8087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-255-5241
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5755 CEDAR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-2999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-718-3160
Provider Business Practice Location Address Fax Number:
443-718-3170
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  D21706 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3532MR . This is a "CAREFIRST MARYLAND #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9534 . This is a "BLUECHOICE #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0200000940 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 261901600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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