Provider Demographics
NPI:1629690631
Name:IBRAHIM, IDIL (MD)
Entity Type:Individual
Prefix:
First Name:IDIL
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-3000
Mailing Address - Fax:202-865-7202
Practice Address - Street 1:2041 GEORGIA AVENUE WASHINGTON, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-1452
Practice Address - Fax:202-865-7202
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2023-04-28
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-03-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program