MEDICARE: EVEIT E GOBRIAL MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D51872	MD

General Provider Information

NPI Number	:	1427231745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVEIT E GOBRIAL MD LLC

Provider Business Mailing Address
First Line	:	2 E ROLLING CROSSROADS
Second Line	:	STE 56
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-6211
Country	:	US
Telephone Number	:	410-747-4272
Fax Number	:	410-747-4918

Provider Business Practice Location Address
First Line	:	2 E ROLLING CROSSROADS
Second Line	:	STE 56
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-6211
Country	:	US
Telephone Number	:	410-747-4272
Fax Number	:	410-747-4918

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	ROBERT LAURENCE HERRMANN JR.
Credential	:
Telephone Number	:	410-882-1440

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	07/22/2013

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