Provider Demographics
NPI:1184367245
Name:IBRAHIM, MARYAM KHALID (MD)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:KHALID
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:KHALID
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH , MD
Mailing Address - Street 1:315 M.L.K. JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2190
Mailing Address - Country:US
Mailing Address - Phone:312-515-2128
Mailing Address - Fax:631-686-7650
Practice Address - Street 1:315 M.L.K. JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-403-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD70001495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine