1518928746 NPI number — DR. TOM GHOBRIAL MD

Table of content: DR. TOM GHOBRIAL MD (NPI 1518928746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518928746 NPI number — DR. TOM GHOBRIAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHOBRIAL
Provider First Name:
TOM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1518928746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12252 WILLIAMS RD SE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-7960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-362-7333
Provider Business Mailing Address Fax Number:
240-362-7391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12252 WILLIAMS RD SE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-7960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-362-7333
Provider Business Practice Location Address Fax Number:
240-362-7391
Provider Enumeration Date:
03/29/2006

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: 174400000X , with the licence number:  D0051379 , 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: 745163600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: WO33 . This is a "CAPITOL BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0098553000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LQ21 . This is a "BLUE SHIELD MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 451653 . This is a "MAMSI/MDIPA/ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 200039203 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6529101-004 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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