1194987073 NPI number — DR. MICHELLE LYNN GHOBRIAL M.D.

Table of content: DR. MICHELLE LYNN GHOBRIAL M.D. (NPI 1194987073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194987073 NPI number — DR. MICHELLE LYNN GHOBRIAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHOBRIAL
Provider First Name:
MICHELLE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDECKI
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194987073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751803
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-277-2200
Provider Business Mailing Address Fax Number:
336-277-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 SILAS CREEK PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-277-2200
Provider Business Practice Location Address Fax Number:
336-277-2210
Provider Enumeration Date:
07/01/2008

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: 2084N0400X , with the licence number:  MD444151 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 2017-00281 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084A2900X , with the licence number: 2017-00281 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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