Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101046968 | VA |
Y | 208600000X | Surgeon | 0101046968 | VA |
N | 208200000X | Surgeon | 25499 | NC |
N | 208600000X | Surgeon | 25499 | NC |
NPI | 1013960814 |
---|---|
Provider Name | Dr. Mohib N I Ghobrial |
First Address | Chesapeake, VA 23320 |
Second Address | Chesapeake, VA 23320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 03/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7310501 | (05) | VA |
C81892 | (02) |