Provider Demographics
NPI:1740202605
Name:HABER, GINA M (AA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:HABER
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:TURCHETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:18697 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3417
Mailing Address - Country:US
Mailing Address - Phone:440-816-6246
Mailing Address - Fax:
Practice Address - Street 1:18697 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3417
Practice Address - Country:US
Practice Address - Phone:440-816-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COANT.0000058367H00000X
OH67-000104367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0583328OtherBCMH
OH2466184Medicaid
OHP00412642OtherMEDICARE RAILROAD
OH000000231022OtherUNISON
OH7302967OtherAETNA
OHP00254432OtherRAILROAD MEDICARE
OH415047OtherWELLCARE MEDICAID
OH000000515979OtherANTHEM
OHP00254432OtherRAILROAD MEDICARE
OHP00412642OtherMEDICARE RAILROAD