Provider Demographics
NPI:1801840178
Name:HABASHI-AHIGIAN, SUSANE MAHER (MD)
Entity Type:Individual
Prefix:
First Name:SUSANE
Middle Name:MAHER
Last Name:HABASHI-AHIGIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSANE
Other - Middle Name:
Other - Last Name:HABASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2266 N HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8254
Mailing Address - Country:US
Mailing Address - Phone:704-483-2200
Mailing Address - Fax:704-483-2214
Practice Address - Street 1:2266 N HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8254
Practice Address - Country:US
Practice Address - Phone:704-483-2200
Practice Address - Fax:704-483-2214
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910419Medicaid
NC8910419Medicaid
D71773Medicare UPIN