Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD035965L | PA |
NPI | 1790856920 |
---|---|
Provider Name | Dr. Michel Goubran |
First Address | Scranton, PA 18505-1651 |
Second Address | Scranton, PA 18505-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C85544 | (02) | NC |