Provider Demographics
NPI:1336678374
Name:MICHEL GOUBRAN MD P.C.
Entity Type:Organization
Organization Name:MICHEL GOUBRAN MD P.C.
Other - Org Name:ST. RITA'S MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUBRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-507-9517
Mailing Address - Street 1:1831 PITTSTON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1651
Mailing Address - Country:US
Mailing Address - Phone:570-507-9517
Mailing Address - Fax:570-507-9520
Practice Address - Street 1:1831 PITTSTON AVE STE 2
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1651
Practice Address - Country:US
Practice Address - Phone:570-507-9517
Practice Address - Fax:570-507-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035965L207QA0401X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty