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General NPI Number Information
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NPI Number | 1053418293
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Entity Type | Organization
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Legal Business Name | CHRISTA HABBOUSHE, MD, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4534 RICHMOND ST
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City | PHILA
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State | PA
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Zip | 19137-2040
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Country | US
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Telephone | 215-743-3335
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Fax | 215-744-2109
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Provider Business Mailing Address
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Address Line | 4534 RICHMOND ST
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City | PHILA
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State | PA
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Zip | 19137-2040
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Country | US
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Telephone | 215-743-3335
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Fax | 215-744-2109
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTA HABBOUSHE
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Credential | MD, LLC
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Telephone | 215-743-3335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD033959L
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License Number State | PA
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