=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801867627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHALID A HABO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2006
-----------------------------------------------------
Last Update Date | 01/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8580 SOUTH AVE STE 2
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44514-3693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-965-7454
-----------------------------------------------------
Fax | 330-965-7459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8580 SOUTH AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44514-3693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-324-6578
-----------------------------------------------------
Fax | 330-776-5557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 35-085977
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------