Provider Demographics
NPI:1891962478
Name:JOULAK, IBRAHIM (MD, FACOG)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:JOULAK
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EAST ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4547
Mailing Address - Country:US
Mailing Address - Phone:978-458-8855
Mailing Address - Fax:978-458-8866
Practice Address - Street 1:60 EAST ST STE 1100
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4547
Practice Address - Country:US
Practice Address - Phone:978-458-8855
Practice Address - Fax:978-458-8866
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090826AMedicaid
MAS400357712OtherMEDICAIR ID