Provider Demographics
NPI:1447310677
Name:HABIB, SALEHA (MD)
Entity type:Individual
Prefix:DR
First Name:SALEHA
Middle Name:
Last Name:HABIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:HABIB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:120 SISTER PIERRE DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7516
Mailing Address - Country:US
Mailing Address - Phone:410-823-0358
Mailing Address - Fax:410-823-8381
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 306
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-823-0358
Practice Address - Fax:410-823-8381
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF2249Medicare UPIN
MD4376Medicare ID - Type Unspecified