Provider Demographics
NPI:1457358442
Name:IBRAHIM, FARHAT (MD)
Entity Type:Individual
Prefix:
First Name:FARHAT
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 1:176 TOLL GATE RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4482
Mailing Address - Country:US
Mailing Address - Phone:401-739-4350
Mailing Address - Fax:401-739-3759
Practice Address - Street 1:176 TOLL GATE RD
Practice Address - Street 2:SUITE #203
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4482
Practice Address - Country:US
Practice Address - Phone:401-739-4350
Practice Address - Fax:401-739-3759
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020734Medicaid
119020734Medicare ID - Type Unspecified
G89476Medicare UPIN