Provider Demographics
NPI:1770508988
Name:IBRAHIM, HANI (MD)
Entity Type:Individual
Prefix:
First Name:HANI
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 1:825 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1659
Mailing Address - Country:US
Mailing Address - Phone:781-337-3424
Mailing Address - Fax:781-340-3782
Practice Address - Street 1:825 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1659
Practice Address - Country:US
Practice Address - Phone:781-337-3424
Practice Address - Fax:781-337-7569
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204792207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG68659Medicare UPIN
MAJ26675Medicare ID - Type Unspecified