Provider Demographics
NPI:1730442443
Name:GHOBRIAL, MARK NASHAAT (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:NASHAAT
Last Name:GHOBRIAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 W SAINT GEORGES AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-3900
Mailing Address - Country:US
Mailing Address - Phone:908-486-1111
Mailing Address - Fax:908-486-2723
Practice Address - Street 1:210 W SAINT GEORGES AVE FL 2
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-3900
Practice Address - Country:US
Practice Address - Phone:908-486-1111
Practice Address - Fax:908-486-2723
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH83566207X00000X
NJ25MB10332000207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery