Provider Demographics
NPI:1225003056
Name:IBRAHIM, SHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERINE
Middle Name:
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 1:4016 BARRETT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6623
Mailing Address - Country:US
Mailing Address - Phone:919-787-5437
Mailing Address - Fax:919-781-6328
Practice Address - Street 1:4016 BARRETT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6623
Practice Address - Country:US
Practice Address - Phone:919-787-5437
Practice Address - Fax:919-781-6328
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7945199Medicaid
NC7945199Medicaid