Provider Demographics
NPI:1043374929
Name:SALIH, IBRAHIM IM (MD)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:IM
Last Name:SALIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10369
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914-0369
Mailing Address - Country:US
Mailing Address - Phone:301-817-3001
Mailing Address - Fax:
Practice Address - Street 1:7610 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4701
Practice Address - Country:US
Practice Address - Phone:301-817-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042461261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD043341100Medicaid
MD0100630OtherUNITED HEALTHCARE
MD73673OtherAMERIGROUP
MD26614OtherPRIORITY PARTNERS