Provider Demographics
NPI:1174785174
Name:HABTEMARIAM, YONATHAN (MD)
Entity type:Individual
Prefix:
First Name:YONATHAN
Middle Name:
Last Name:HABTEMARIAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 N 15TH ST
Mailing Address - Street 2:APT. # 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3416
Mailing Address - Country:US
Mailing Address - Phone:703-593-7159
Mailing Address - Fax:
Practice Address - Street 1:641 N 15TH ST
Practice Address - Street 2:APT. # 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3416
Practice Address - Country:US
Practice Address - Phone:703-593-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193791207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine