Provider Demographics
NPI:1457439788
Name:HABRE, ANTOINE GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:GEORGE
Last Name:HABRE
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 1:590 W RIDGE RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1094
Mailing Address - Country:US
Mailing Address - Phone:276-228-8800
Mailing Address - Fax:276-228-8808
Practice Address - Street 1:590 W RIDGE RD
Practice Address - Street 2:STE I
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1094
Practice Address - Country:US
Practice Address - Phone:276-228-8800
Practice Address - Fax:276-228-8808
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240438207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH47145Medicare UPIN
VA014962W82Medicare PIN
VAP00622858Medicare PIN