Provider Demographics
NPI:1447525654
Name:HABIB, LARISSA ANN (MD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:ANN
Last Name:HABIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LARISSA
Other - Middle Name:ANN
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1817 BLACK ROCK TPKE STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3546
Mailing Address - Country:US
Mailing Address - Phone:032-420-0228
Mailing Address - Fax:
Practice Address - Street 1:1817 BLACK ROCK TPKE STE 204
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3546
Practice Address - Country:US
Practice Address - Phone:203-424-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63953207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery