Organization
KENANVILLE SURGICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHIB N.I. GHOBRIAL M.D. (OWNER)
(757) 436-3630
Entity
Organization
Contact information
Practice address
109 WIMBLEDON SQ STE C, CHESAPEAKE, VA 23320-4945
(757) 436-3630
Mailing address
109 WIMBLEDON SQ STE C, CHESAPEAKE, VA 23320-4945
(757) 436-3630
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
09/12/2011
Last updated
09/12/2011
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