Provider Demographics
NPI:1477557106
Name:IBRAHIM, AHMER (MD)
Entity Type:Individual
Prefix:
First Name:AHMER
Middle Name:
Last Name:IBRAHIM
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 1:260 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2192
Mailing Address - Country:US
Mailing Address - Phone:978-499-7200
Mailing Address - Fax:978-499-7216
Practice Address - Street 1:260 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2192
Practice Address - Country:US
Practice Address - Phone:978-499-7200
Practice Address - Fax:978-499-7216
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204865Medicaid
NHI24821OtherANTHEM BLUE CROSS
NH30204865OtherNH MEDICAID
MA467864OtherTUFTS HEALTH PLAN
6831015OtherHEALTHSOURCE
0035472OtherNEIGHBORHOOD HEALTH PLAN
04-07806OtherEVERCARE
MA110040419AMedicaid
6356194OtherCIGNA
968566OtherNETWORK HEALTH
MAJ28478OtherBLUE CROSS BLUE SHIELD
MAJ28478OtherBLUE CROSS BLUE SHIELD
MAI24821Medicare UPIN