Provider Demographics
NPI:1003892217
Name:GHOUBRIAL, SAM N (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:N
Last Name:GHOUBRIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:195 WADSWORTH RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281
Mailing Address - Country:US
Mailing Address - Phone:330-331-7207
Mailing Address - Fax:330-331-7587
Practice Address - Street 1:195 WADSWORTH RD
Practice Address - Street 2:SUITE 402
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281
Practice Address - Country:US
Practice Address - Phone:330-331-7207
Practice Address - Fax:330-331-7587
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-067926207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140056Medicaid
OHGH4144681Medicare ID - Type Unspecified
SA0781467Medicare PIN
OHG02372Medicare UPIN
OH0140056Medicaid