Provider Demographics
NPI:1619924651
Name:HABR, FADLALLAH G (MD)
Entity Type:Individual
Prefix:
First Name:FADLALLAH
Middle Name:G
Last Name:HABR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 VIRGINIA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4406
Mailing Address - Country:US
Mailing Address - Phone:401-443-4992
Mailing Address - Fax:401-784-4902
Practice Address - Street 1:375 WAMPANOAG TRL
Practice Address - Street 2:SUITE 202A
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2212
Practice Address - Country:US
Practice Address - Phone:401-649-4030
Practice Address - Fax:401-649-4031
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD09914207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9021243Medicaid
RI007056296Medicare PIN