Provider Demographics
NPI:1356435739
Name:HABAS, JOELLEN (MD)
Entity type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:HABAS
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 1:806 ACQUONI ROAD
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-0666
Mailing Address - Country:US
Mailing Address - Phone:828-497-1991
Mailing Address - Fax:828-497-8194
Practice Address - Street 1:806 ACQUONI ROAD
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-0666
Practice Address - Country:US
Practice Address - Phone:828-497-1991
Practice Address - Fax:828-497-8194
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01989207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2284898Medicaid
D88804Medicare UPIN
343505200Medicare ID - Type Unspecified