Provider Demographics
NPI:1508875451
Name:HABASHY, WAGDY M (MD)
Entity Type:Individual
Prefix:
First Name:WAGDY
Middle Name:M
Last Name:HABASHY
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 1:31 DOW RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374
Mailing Address - Country:US
Mailing Address - Phone:860-564-6296
Mailing Address - Fax:860-230-0446
Practice Address - Street 1:31 DOW RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374
Practice Address - Country:US
Practice Address - Phone:860-564-6296
Practice Address - Fax:860-230-0446
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001362631Medicaid
G54367Medicare UPIN
CT110006864Medicare ID - Type Unspecified