Provider Demographics
NPI:1518969195
Name:ELGABRY, IBRAHIM A (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:A
Last Name:ELGABRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:191 SOCIAL ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:401-597-6500
Mailing Address - Fax:401-597-6509
Practice Address - Street 1:191 SOCIAL ST
Practice Address - Street 2:SUITE #100
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-597-6500
Practice Address - Fax:401-597-6509
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD13508207RC0000X
NJ25MA07714300207R00000X
PAMD430853207RC0000X
MA253653207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0047015Medicaid
PA101944413Medicaid
NJI23131Medicare UPIN
PA101944413Medicaid
PA113111Medicare PIN