Healthcare Provider Details

I. General information

NPI: 1275688442
Provider Name (Legal Business Name): FARHAN IBRAHIMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10,010 K SHOPS WAY
NORTHBOROUGH MA
01532
US

IV. Provider business mailing address

1215 BROADWAY
RAYNHAM MA
02767-1942
US

V. Phone/Fax

Practice location:
  • Phone: 508-936-3866
  • Fax:
Mailing address:
  • Phone: 508-894-0400
  • Fax: 508-565-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number236049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: