Provider Demographics
NPI:1609806025
Name:HARB, TED (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:HARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LABA RAMEZ
Other - Middle Name:
Other - Last Name:SAMIA-HARB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3848 F.A.U. BLVD SUITE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-826-1134
Mailing Address - Fax:561-826-1134
Practice Address - Street 1:3848 FAU BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-362-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010760292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00256904OtherRAILROAD MEDICARE
MI4787546Medicaid
MI4878555Medicaid
MI4878555Medicaid
MI4787546Medicaid
MI4878555Medicaid