Provider Demographics
NPI:1790739910
Name:GOBRIAL, EVEIT E (MD)
Entity Type:Individual
Prefix:
First Name:EVEIT
Middle Name:E
Last Name:GOBRIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E ROLLING CROSSROADS STE 56
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6212
Mailing Address - Country:US
Mailing Address - Phone:410-747-4272
Mailing Address - Fax:410-747-4918
Practice Address - Street 1:2 E ROLLING CROSSROADS STE 56
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6212
Practice Address - Country:US
Practice Address - Phone:410-747-4272
Practice Address - Fax:410-747-4918
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD587900100Medicaid
P00399190Medicare PIN
963M767FMedicare PIN
MD587900100Medicaid