Healthcare Provider Details

I. General information

NPI: 1063890895
Provider Name (Legal Business Name): LEAH HABERSHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 09/15/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 S RIVER ST STE 111
PLAINS PA
18705-1033
US

IV. Provider business mailing address

672 S RIVER ST STE 111
PLAINS PA
18705-1033
US

V. Phone/Fax

Practice location:
  • Phone: 570-552-7150
  • Fax: 570-552-7155
Mailing address:
  • Phone: 570-552-7150
  • Fax: 570-552-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number302830
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD90096
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD466961
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: