Provider Demographics
NPI:1669457982
Name:HABIB, GREGORY FLINN (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:FLINN
Last Name:HABIB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1116
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-1116
Mailing Address - Country:US
Mailing Address - Phone:412-207-9780
Mailing Address - Fax:412-207-9782
Practice Address - Street 1:345 MOUNT LEBANON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1504
Practice Address - Country:US
Practice Address - Phone:412-207-9780
Practice Address - Fax:412-207-9782
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013015207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10109443001Medicaid
PAI14437Medicare UPIN
PA082455E0DMedicare PIN