Provider Demographics
NPI:1043221732
Name:IBRAHIM, ALIA AHMED (MD)
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:AHMED
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 JENA CIRCLE
Mailing Address - Street 2:#202
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113
Mailing Address - Country:US
Mailing Address - Phone:443-538-5069
Mailing Address - Fax:
Practice Address - Street 1:3001 HOSPITAL DRIVE
Practice Address - Street 2:UNIVERITY OF MARYLAND
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:301-618-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE346207Q00000X
MDD71852207Q00000X, 207P00000X
DCMD042495207P00000X
NY248663207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine