Provider Demographics
NPI:1710291083
Name:IBRAHIM IM SALIH MD PC
Entity Type:Organization
Organization Name:IBRAHIM IM SALIH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:IM
Authorized Official - Last Name:SALIH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-817-3001
Mailing Address - Street 1:PO BOX 10369
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914-0369
Mailing Address - Country:US
Mailing Address - Phone:301-817-3001
Mailing Address - Fax:301-817-3005
Practice Address - Street 1:7610 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747
Practice Address - Country:US
Practice Address - Phone:301-817-3001
Practice Address - Fax:301-817-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042461207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD043341100Medicaid
MD508449OtherMEDICARE PROVIDER NUMBER
MD043341100Medicaid