Provider Demographics
NPI:1255424404
Name:IBRAHIM, FAHMY (MD)
Entity type:Individual
Prefix:
First Name:FAHMY
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:FAHMY
Other - Middle Name:
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:500 N 9TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5814
Mailing Address - Country:US
Mailing Address - Phone:209-525-5300
Mailing Address - Fax:209-209-5255
Practice Address - Street 1:500 N 9TH ST STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5814
Practice Address - Country:US
Practice Address - Phone:209-525-5300
Practice Address - Fax:209-209-5255
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA894552084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02618720Medicaid