Healthcare Provider Details

I. General information

NPI: 1043374929
Provider Name (Legal Business Name): IBRAHIM I.M. SALIH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
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
FORESTVILLE MD
20747-4701
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:
Mailing address:
  • Phone: 301-817-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD0042461
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: