Healthcare Provider Details

I. General information

NPI: 1710291083
Provider Name (Legal Business Name): IBRAHIM IM SALIH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 PENNSYLVANIA AVE SUITE 200
DISTRICT HEIGHTS MD
20747
US

IV. Provider business mailing address

PO BOX 10369
SILVER SPRING MD
20914-0369
US

V. Phone/Fax

Practice location:
  • Phone: 301-817-3001
  • Fax: 301-817-3005
Mailing address:
  • Phone: 301-817-3001
  • Fax: 301-817-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0042461
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD0042461
License Number StateMD

VIII. Authorized Official

Name: DR. IBRAHIM I.M. SALIH
Title or Position: OWNER
Credential:
Phone: 301-817-3001