Provider Demographics
NPI:1427231745
Name:EVEIT E GOBRIAL MD LLC
Entity Type:Organization
Organization Name:EVEIT E GOBRIAL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-882-1440
Mailing Address - Street 1:2 E ROLLING CROSSROADS
Mailing Address - Street 2:STE 56
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6211
Mailing Address - Country:US
Mailing Address - Phone:410-747-4272
Mailing Address - Fax:410-747-4918
Practice Address - Street 1:2 E ROLLING CROSSROADS
Practice Address - Street 2:STE 56
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6211
Practice Address - Country:US
Practice Address - Phone:410-747-4272
Practice Address - Fax:410-747-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
963MMedicare PIN