=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386171973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FATIMA MOHAMED JIBREL MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2017
-----------------------------------------------------
Last Update Date | 08/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 PLAIN STREET 5TH FLOOR
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-4829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-453-7560
-----------------------------------------------------
Fax | 401-453-7573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 TOLL GATE RD, PRC AND CRED
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-2759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-273-0641
-----------------------------------------------------
Fax | 401-273-2919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD17541
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VF0040X
-----------------------------------------------------
Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number | MD17541
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------