Provider Demographics
NPI:1881630432
Name:HABBOUSHE, FAWZI P (MD)
Entity Type:Individual
Prefix:DR
First Name:FAWZI
Middle Name:P
Last Name:HABBOUSHE
Suffix:
Gender:M
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:PEPPER PAVILION STE 1100
Mailing Address - Street 2:ONE GRADUATE PLAZA
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19146
Mailing Address - Country:US
Mailing Address - Phone:215-735-4223
Mailing Address - Fax:215-735-3704
Practice Address - Street 1:PEPPER PAVILION STE 1100
Practice Address - Street 2:ONE GRADUATE PLAZA
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:215-735-4223
Practice Address - Fax:215-735-3704
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD304692L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0052113000OtherKEYSTONE HPE
PA163775OtherBC/BS
PA07545OtherSENIOR PARTNERS
PA0072520401OtherAMERIHEALTH
PA049958OtherAETNA
PA0072520401Medicaid
PA32169OtherKEYSTONE MERCY
PA0007252040005Medicaid
PA07545OtherHEALTH PARTNERS
PA6295282001OtherCIGNA
B40422Medicare UPIN
PA0072520401Medicaid