Provider Demographics
NPI:1033130802
Name:GHEBA, MOHAMMED R (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:R
Last Name:GHEBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7087
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-8087
Mailing Address - Country:US
Mailing Address - Phone:443-255-5241
Mailing Address - Fax:
Practice Address - Street 1:5755 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2999
Practice Address - Country:US
Practice Address - Phone:443-718-3160
Practice Address - Fax:443-718-3170
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3532MROtherCAREFIRST MARYLAND #
MD9534OtherBLUECHOICE #
MD0200000940OtherRAILROAD MEDICARE #
MD261901600Medicaid
MD261901600Medicaid
MD9534OtherBLUECHOICE #