Provider Demographics
NPI:1851961726
Name:EBRAHEEM, ADEL (MS, OD)
Entity Type:Individual
Prefix:DR
First Name:ADEL
Middle Name:
Last Name:EBRAHEEM
Suffix:
Gender:M
Credentials:MS, OD
Other - Prefix:DR
Other - First Name:ADEL
Other - Middle Name:
Other - Last Name:EBRAHEEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OD
Mailing Address - Street 1:2501 MARYLAND RD APT P6
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1838
Mailing Address - Country:US
Mailing Address - Phone:630-303-6301
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST STE 470
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7009
Practice Address - Country:US
Practice Address - Phone:667-214-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist