Healthcare Provider Details

I. General information

NPI: 1912227471
Provider Name (Legal Business Name): JOSEPH REZA HABIBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 DISCOVERY PARK BLVD SUITE 203
WILLIAMSBURG VA
23188-2904
US

IV. Provider business mailing address

5424 DISCOVERY PARK BLVD SUITE 203
WILLIAMSBURG VA
23188-2904
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-6223
  • Fax: 757-903-4808
Mailing address:
  • Phone: 757-345-6223
  • Fax: 757-903-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD28577
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116022424
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101258323
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: