Provider Demographics
NPI:1649216623
Name:SHABAN, HAIFA ALJANABI (MD)
Entity Type:Individual
Prefix:DR
First Name:HAIFA
Middle Name:ALJANABI
Last Name:SHABAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13811 BISON CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2000
Mailing Address - Country:US
Mailing Address - Phone:301-871-2077
Mailing Address - Fax:301-576-3634
Practice Address - Street 1:15005 SHADY GROVE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6340
Practice Address - Country:US
Practice Address - Phone:301-762-9413
Practice Address - Fax:301-576-3634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040803208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDSH680852Medicare ID - Type Unspecified
MDE92833Medicare UPIN