Provider Demographics
NPI:1013638741
Name:HALBONI, DALIAH WALID (FNP)
Entity Type:Individual
Prefix:
First Name:DALIAH
Middle Name:WALID
Last Name:HALBONI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9346 SHARP ANTLER
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5213
Mailing Address - Country:US
Mailing Address - Phone:443-813-3005
Mailing Address - Fax:
Practice Address - Street 1:6350 STEVENS FOREST RD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3240
Practice Address - Country:US
Practice Address - Phone:443-259-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine