MEDICARE: DR. FAWZI P HABBOUSHE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD304692L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0052113000	OTHER	PA	KEYSTONE HPE
2	163775	OTHER	PA	BC/BS
3	07545	OTHER	PA	SENIOR PARTNERS
4	0072520401	OTHER	PA	AMERIHEALTH
5	049958	OTHER	PA	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	32169	OTHER	PA	KEYSTONE MERCY
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	07545	OTHER	PA	HEALTH PARTNERS
10	6295282001	OTHER	PA	CIGNA

General Provider Information

NPI Number	:	1881630432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAWZI P HABBOUSHE M.D.

Provider Business Mailing Address
First Line	:	PEPPER PAVILION STE 1100
Second Line	:	ONE GRADUATE PLAZA
City	:	PHILA
State	:	PA
Zip	:	19146
Country	:	US
Telephone Number	:	215-735-4223
Fax Number	:	215-735-3704

Provider Business Practice Location Address
First Line	:	PEPPER PAVILION STE 1100
Second Line	:	ONE GRADUATE PLAZA
City	:	PHILA
State	:	PA
Zip	:	19146
Country	:	US
Telephone Number	:	215-735-4223
Fax Number	:	215-735-3704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	10/12/2007

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Directions to “ DR. FAWZI P HABBOUSHE M.D.” Practice Location

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