Provider Demographics
NPI:1598858045
Name:BHUTTA, HABIB A (MD)
Entity type:Individual
Prefix:
First Name:HABIB
Middle Name:A
Last Name:BHUTTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14201 LAUREL PARK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5203
Mailing Address - Country:US
Mailing Address - Phone:301-490-3443
Mailing Address - Fax:301-490-0200
Practice Address - Street 1:14201 LAUREL PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:301-490-3443
Practice Address - Fax:301-490-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-11-22
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Provider Licenses
StateLicense IDTaxonomies
MDD0024364208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD781621900Medicaid
MD089767Medicare ID - Type Unspecified
MD781621900Medicaid