Provider Demographics
NPI:1346634326
Name:IBRAHEM, MARWAH
Entity Type:Individual
Prefix:
First Name:MARWAH
Middle Name:
Last Name:IBRAHEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3815
Mailing Address - Country:US
Mailing Address - Phone:203-852-2000
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3815
Practice Address - Country:US
Practice Address - Phone:203-852-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2022-07-01
Deactivation Date:2022-06-03
Deactivation Code:
Reactivation Date:2022-07-01
Provider Licenses
StateLicense IDTaxonomies
CT69745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine