MEDICARE: DR. CHRISTA P HABBOUSHE M.D.

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	207Q00000X	Family Medicine Physician	MD033959L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00461430001	OTHER	PA	PENNSYLVANIA BLUE SHIELD
2	0046143000	OTHER	PA	PPO INDEPN BLUE SHIELD
3	0046143001	OTHER	PA	KEYSTONE HEALTHPALN EAST
4	03707	OTHER	PA	HEALTH PARTNERS
5	10226	OTHER	PA	KEYSTONE MERCY
6	001351	OTHER	PA	AETNA
7	173824	OTHER	PA	BLUE CROSS BLUE SHIELD
8	00732924005	OTHER	PA	AMERICHOICE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912964750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTA P HABBOUSHE M.D.

Provider Business Mailing Address
First Line	:	4534 RICHMOND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-2040
Country	:	US
Telephone Number	:	215-743-3335
Fax Number	:	215-744-2109

Provider Business Practice Location Address
First Line	:	4534 RICHMOND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-2040
Country	:	US
Telephone Number	:	215-743-3335
Fax Number	:	215-744-2109

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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