Provider Demographics
NPI:1225040397
Name:GHOBRIEL, MARIAM (MD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:GHOBRIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:111
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2554
Mailing Address - Country:US
Mailing Address - Phone:732-303-0102
Mailing Address - Fax:732-637-8539
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:111
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2554
Practice Address - Country:US
Practice Address - Phone:732-303-0102
Practice Address - Fax:732-637-8539
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA007975600207LP2900X
NJ25MA07975600208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine