Provider Demographics
NPI:1841407749
Name:GHABRAS, MAGDA S (DO)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:S
Last Name:GHABRAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-738-2420
Mailing Address - Fax:
Practice Address - Street 1:876 SAXON BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8214
Practice Address - Country:US
Practice Address - Phone:386-774-0491
Practice Address - Fax:866-287-2426
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08392800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0222453Medicaid