Healthcare Provider Details

I. General information

NPI: 1043221732
Provider Name (Legal Business Name): ALIA AHMED IBRAHIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DRIVE UNIVERITY OF MARYLAND
CHEVERLY MD
20785
US

IV. Provider business mailing address

310 JENA CIRCLE #202
ODENTON MD
21113
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-2947
  • Fax:
Mailing address:
  • Phone: 443-538-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD042495
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number248663
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD71852
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD71852
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: