Healthcare Provider Details

I. General information

NPI: 1821170911
Provider Name (Legal Business Name): SAM N GHOUBRIAL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 WADSWORTH RD. SUITE 402
WADSWORTH OH
44281
US

IV. Provider business mailing address

3535 GRANGER RD
AKRON OH
44333-1538
US

V. Phone/Fax

Practice location:
  • Phone: 330-331-7207
  • Fax: 330-331-7587
Mailing address:
  • Phone: 330-331-7207
  • Fax: 330-331-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35067926
License Number StateOH

VIII. Authorized Official

Name: CRYSTAL PELFREY
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-331-7207