Provider Demographics
NPI:1912964750
Name:HABBOUSHE, CHRISTA P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:P
Last Name:HABBOUSHE
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 1:4534 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137-2040
Mailing Address - Country:US
Mailing Address - Phone:215-743-3335
Mailing Address - Fax:215-744-2109
Practice Address - Street 1:4534 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-2040
Practice Address - Country:US
Practice Address - Phone:215-743-3335
Practice Address - Fax:215-744-2109
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033959L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00461430001OtherPENNSYLVANIA BLUE SHIELD
PA0046143000OtherPPO INDEPN BLUE SHIELD
PA0046143001OtherKEYSTONE HEALTHPALN EAST
PA03707OtherHEALTH PARTNERS
PA10226OtherKEYSTONE MERCY
PA001351OtherAETNA
PA173824OtherBLUE CROSS BLUE SHIELD
PA00732924005OtherAMERICHOICE
PA00732924005Medicaid
PA001351OtherAETNA
PA173824OtherBLUE CROSS BLUE SHIELD