MEDICARE: DR. MARIA A IBARRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	9401417	NC

General Provider Information

NPI Number	:	1205818473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA A IBARRA MD

Provider Business Mailing Address
First Line	:	PO BOX 14883
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27415-4883
Country	:	US
Telephone Number	:	336-274-6515
Fax Number	:	336-691-8042

Provider Business Practice Location Address
First Line	:	1210 NEW GARDEN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2721
Country	:	US
Telephone Number	:	336-852-1915
Fax Number	:	336-294-3544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	04/22/2021

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