Healthcare Provider Details

I. General information

NPI: 1811682743
Provider Name (Legal Business Name): BISHOY NAZIH IBRAHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1215
US

IV. Provider business mailing address

3000 NEW BERN AVE
RALEIGH NC
27610-1215
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-2011
  • Fax:
Mailing address:
  • Phone: 984-974-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2026-02290
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: