Provider Demographics
NPI:1164266128
Name:KHRAIS, IBRAHIM ABDEL QADER IBRAHIM (MD)
Entity type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:ABDEL QADER IBRAHIM
Last Name:KHRAIS
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 1:55 FRUIT ST. MGH TRANSPLANT SURGERY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST. WHITE FIVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2025-07-24
Deactivation Date:2025-03-07
Deactivation Code:
Reactivation Date:2025-07-24
Provider Licenses
StateLicense IDTaxonomies
MA3015681204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery