Provider Demographics
NPI:1912227471
Name:HABIBI, JOSEPH REZA (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:REZA
Last Name:HABIBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5424 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2904
Mailing Address - Country:US
Mailing Address - Phone:757-345-6223
Mailing Address - Fax:757-903-4808
Practice Address - Street 1:5424 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2904
Practice Address - Country:US
Practice Address - Phone:757-345-6223
Practice Address - Fax:757-903-4808
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116022424390200000X
VA0101258323208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program