1386171973 NPI number — FATIMA MOHAMED JIBREL MD

Table of content: FATIMA MOHAMED JIBREL MD (NPI 1386171973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386171973 NPI number — FATIMA MOHAMED JIBREL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIBREL
Provider First Name:
FATIMA
Provider Middle Name:
MOHAMED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1386171973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 TOLL GATE RD, PRC AND CRED
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-273-0641
Provider Business Mailing Address Fax Number:
401-273-2919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PLAIN STREET
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-453-7560
Provider Business Practice Location Address Fax Number:
401-453-7573
Provider Enumeration Date:
05/15/2017

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:  MD17541 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VF0040X , with the licence number: MD17541 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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