Healthcare Provider Details

I. General information

NPI: 1336133545
Provider Name (Legal Business Name): RICHARD CHRISTIAN HABERSAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MOUNT CARMEL RD SUITE 500
PARKTON MD
21120-9706
US

IV. Provider business mailing address

111 MT CARMEL ROAD
PARKTON MD
21120
US

V. Phone/Fax

Practice location:
  • Phone: 410-343-1020
  • Fax: 410-343-2494
Mailing address:
  • Phone: 410-343-1020
  • Fax: 410-343-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberD18822
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: