Healthcare Provider Details

I. General information

NPI: 1871567495
Provider Name (Legal Business Name): WALEED ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WALEED IBRAHIMALI

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/09/2021
Certification Date: 03/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-4083
  • Fax: 360-486-6436
Mailing address:
  • Phone: 360-486-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60608443
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60608443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: