Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 10704 | WV |
NPI | 1104888171 |
---|---|
Provider Name | Afif S Habash |
First Address | Charleston, WV 25304-2052 |
Second Address | Charleston, WV 25304-2052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 29/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105028000 | (05) | WV |
F74101 | (02) | WV |