Provider Demographics
NPI:1013960814
Name:GHOBRIAL, MOHIB N I (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHIB
Middle Name:N I
Last Name:GHOBRIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109C WIMBLEDON SQUARE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-436-3630
Mailing Address - Fax:757-312-0815
Practice Address - Street 1:109C WIMBLEDON SQUARE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-436-3630
Practice Address - Fax:757-312-0815
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046968208600000X
NC25499208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7310501Medicaid
VA7310501Medicaid
C81892Medicare UPIN