Provider Demographics
NPI:1407053713
Name:HABIB, AYSHA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:AYSHA
Middle Name:
Last Name:HABIB
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 HICKORY PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2624
Mailing Address - Country:US
Mailing Address - Phone:804-612-2980
Mailing Address - Fax:804-762-7102
Practice Address - Street 1:12320 W BROAD ST STE 204
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7603
Practice Address - Country:US
Practice Address - Phone:804-612-2980
Practice Address - Fax:804-762-7102
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
VAC06695OtherGROUP PTAN