Provider Demographics
NPI:1336133545
Name:HABERSAT, RICHARD CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHRISTIAN
Last Name:HABERSAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MT CARMEL ROAD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120
Mailing Address - Country:US
Mailing Address - Phone:410-343-1020
Mailing Address - Fax:410-343-2494
Practice Address - Street 1:111 MOUNT CARMEL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9706
Practice Address - Country:US
Practice Address - Phone:410-343-1020
Practice Address - Fax:410-343-2494
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18822207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD258171000Medicaid
MDB69503Medicare UPIN
MD119RMedicare ID - Type UnspecifiedMEDICARE NUMBER