Provider Demographics
NPI:1386781870
Name:HABIB, TAHIRA (MD)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:
Last Name:HABIB
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 1:6355 WALKER LN
Mailing Address - Street 2:SUITE 411
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3245
Mailing Address - Country:US
Mailing Address - Phone:703-719-6715
Mailing Address - Fax:703-719-5762
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 411
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-719-6715
Practice Address - Fax:703-719-5762
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037992207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541473282OtherTAX ID #
DC8603OtherCAREFIRST OF DC
VA528482Medicare PIN
VA541473282OtherTAX ID #