Provider Demographics
NPI:1720548845
Name:WADA, HABIBA ISA (MD)
Entity Type:Individual
Prefix:DR
First Name:HABIBA
Middle Name:ISA
Last Name:WADA
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 1:3540 CRAIN HWY
Mailing Address - Street 2:PO BOX #146
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5009 HONEYGO CENTER DR STE 225
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9843
Practice Address - Country:US
Practice Address - Phone:443-725-2100
Practice Address - Fax:443-725-2121
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0095125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics