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General NPI Number Information
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NPI Number | 1154673713
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Entity Type | Individual
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Provider Name | WALEED IBRAHIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 4723 COMMONS DR APT 304
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City | ANNANDALE
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State | VA
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Zip | 22003-5066
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Country | US
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Telephone | 760-444-3076
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Fax |
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Provider Business Mailing Address
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Address Line | 4723 COMMONS DR APT 304
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City | ANNANDALE
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State | VA
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Zip | 22003-5066
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Country | US
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Telephone | 760-444-3076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301072946
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 200300815
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License Number State | NC
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