1477557106 NPI number — AHMER IBRAHIM M.D.

Table of content: AHMER IBRAHIM M.D. (NPI 1477557106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477557106 NPI number — AHMER IBRAHIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IBRAHIM
Provider First Name:
AHMER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477557106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 MERRIMAC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950-2192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-499-7200
Provider Business Mailing Address Fax Number:
978-499-7216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 MERRIMAC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-2192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-499-7200
Provider Business Practice Location Address Fax Number:
978-499-7216
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  213909 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30204865 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: I24821 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30204865 . This is a "NH MEDICAID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 467864 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6831015 . This is a "HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0035472 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04-07806 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110040419A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6356194 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 968566 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J28478 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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