MEDICARE: FADLALLAH G HABR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD09914	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619924651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FADLALLAH G HABR MD

Provider Business Mailing Address
First Line	:	17 VIRGINIA AVE
Second Line	:	SUITE 107
City	:	PROVIDENCE
State	:	RI
Zip	:	02905-4406
Country	:	US
Telephone Number	:	401-443-4992
Fax Number	:	401-784-4902

Provider Business Practice Location Address
First Line	:	375 WAMPANOAG TRL
Second Line	:	SUITE 202A
City	:	RIVERSIDE
State	:	RI
Zip	:	02915-2212
Country	:	US
Telephone Number	:	401-649-4030
Fax Number	:	401-649-4031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/27/2016

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