Provider Demographics
NPI:1568697985
Name:IBRAHIM, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
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 1:605 SAUCON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5079
Mailing Address - Country:US
Mailing Address - Phone:610-597-3868
Mailing Address - Fax:
Practice Address - Street 1:537 STANTON CHRISTIANA RD STE 102
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2145
Practice Address - Country:US
Practice Address - Phone:302-892-9900
Practice Address - Fax:302-892-9980
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0012386208600000X
PAMD451901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA416056V8GMedicare PIN