MEDICARE: DR. ANTHONY ISAAC GHOBRIAL MD

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	207R00000X	Internal Medicine Physician	MT231000	PA

General Provider Information

NPI Number	:	1427899855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY ISAAC GHOBRIAL MD

Provider Business Mailing Address
First Line	:	4055 RIDGE AVE APT 7302
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1594
Country	:	US
Telephone Number	:	724-575-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2421
Country	:	US
Telephone Number	:	800-836-7536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	05/31/2024

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