Provider Demographics
NPI:1457325847
Name:HABAN, GREGORY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:HABAN
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 1:4860 FRANK RD NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7426
Mailing Address - Country:US
Mailing Address - Phone:330-494-7099
Mailing Address - Fax:330-494-2147
Practice Address - Street 1:4860 FRANK RD NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7426
Practice Address - Country:US
Practice Address - Phone:330-494-7099
Practice Address - Fax:330-494-2147
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039623H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0461772Medicaid
OHA77767Medicare UPIN
OHHA0452003Medicare PIN