Provider Demographics
NPI:1063890895
Name:HABERSHAM, LEAH (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HABERSHAM
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 1:672 S RIVER ST STE 111
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1033
Mailing Address - Country:US
Mailing Address - Phone:570-552-7150
Mailing Address - Fax:570-552-7155
Practice Address - Street 1:672 S RIVER ST STE 111
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1033
Practice Address - Country:US
Practice Address - Phone:570-552-7150
Practice Address - Fax:570-552-7155
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302830207QA0401X
MDD90096207V00000X
PAMD466961207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine