Provider Demographics
NPI:1346304318
Name:IPAKCHI, EBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:EBRAHIM
Middle Name:
Last Name:IPAKCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 YORK RD
Mailing Address - Street 2:SUITE 26
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6210
Mailing Address - Country:US
Mailing Address - Phone:410-532-1640
Mailing Address - Fax:410-321-5787
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:SUITE 26
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-532-1640
Practice Address - Fax:410-321-5787
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025686207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD793331200Medicaid
4477Medicare ID - Type Unspecified
MD793331200Medicaid