Provider Demographics
NPI:1972717437
Name:TOM GHOBRIAL, MD. LLC
Entity Type:Organization
Organization Name:TOM GHOBRIAL, MD. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-362-7370
Mailing Address - Street 1:12252 WILLIAMS RD SE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7960
Mailing Address - Country:US
Mailing Address - Phone:240-362-7370
Mailing Address - Fax:
Practice Address - Street 1:12252 WILLIAMS RD SE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7960
Practice Address - Country:US
Practice Address - Phone:240-362-7370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051379207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD745163600Medicaid
MD4810280001Medicare NSC
MD319RMedicare PIN
MDG52076Medicare UPIN