Individual
IBRAHIM ISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
169 ASHLEY AVE RM 202, MSC 333, CHARLESTON, SC 29425-8905
(843) 792-9705
Mailing address
169 ASHLEY AVE RM 202, MSC 333, CHARLESTON, SC 29425-8905
(843) 792-9705
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
LL36898
SC
Other
Enumeration date
06/17/2014
Last updated
06/17/2014
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