Provider Demographics
NPI:1104888171
Name:HABASH, AFIF S (MD)
Entity type:Individual
Prefix:
First Name:AFIF
Middle Name:S
Last Name:HABASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2052
Mailing Address - Country:US
Mailing Address - Phone:304-925-1115
Mailing Address - Fax:304-925-1117
Practice Address - Street 1:4920 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2052
Practice Address - Country:US
Practice Address - Phone:304-442-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107042080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0105028000Medicaid
WVF74101Medicare UPIN
WV0105028000Medicaid