MEDICARE: MR. IBRAHIM AHMED NASIR HERSI M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720915358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IBRAHIM AHMED NASIR HERSI M.D.

Provider Business Mailing Address
First Line	:	THE GW MEDICAL FACULTY ASSOCIATES
Second Line	:	2150 PENNSYLVANIA AVENUE, NW
City	:	WASHINGTON
State	:	DC
Zip	:	20037
Country	:	US
Telephone Number	:	202-741-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	THE GW MEDICAL FACULTY ASSOCIATES
Second Line	:	2150 PENNSYLVANIA AVENUE, NW
City	:	WASHINGTON
State	:	DC
Zip	:	20037
Country	:	US
Telephone Number	:	202-741-3000
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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