Healthcare Provider Details

I. General information

NPI: 1447196845
Provider Name (Legal Business Name): IBRAHIM ABDELMONEIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE # 3084
BOSTON MA
02115-5724
US

IV. Provider business mailing address

1223 BEACON ST APT 400
BROOKLINE MA
02446-5391
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-1914
  • Fax: 617-730-0214
Mailing address:
  • Phone: 857-421-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number3019776
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: