Provider Demographics
NPI:1245404532
Name:IBRAHIM, MOHAMED ABDELRAHIM YOUSIF (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDELRAHIM YOUSIF
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMED
Other - Middle Name:ABDELRAHIM
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843200
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3200
Mailing Address - Country:US
Mailing Address - Phone:910-417-3477
Mailing Address - Fax:910-417-3489
Practice Address - Street 1:110 MEDICAL CIR
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5220
Practice Address - Country:US
Practice Address - Phone:910-417-3477
Practice Address - Fax:910-417-3489
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800166207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914863Medicaid
NC5914863Medicaid