1245404532 NPI number — MOHAMED ABDELRAHIM YOUSIF IBRAHIM MD

Table of content: MOHAMED ABDELRAHIM YOUSIF IBRAHIM MD (NPI 1245404532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245404532 NPI number — MOHAMED ABDELRAHIM YOUSIF IBRAHIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IBRAHIM
Provider First Name:
MOHAMED
Provider Middle Name:
ABDELRAHIM YOUSIF
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IBRAHIM
Provider Other First Name:
MOHAMED
Provider Other Middle Name:
ABDELRAHIM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245404532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-417-3477
Provider Business Mailing Address Fax Number:
910-417-3489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 MEDICAL CIR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ROCKINGHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28379-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-417-3477
Provider Business Practice Location Address Fax Number:
910-417-3489
Provider Enumeration Date:
04/17/2008

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: 207V00000X , with the licence number:  200800166 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5914863 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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