Provider Demographics
NPI:1487924759
Name:WAGDY M HABASHY MD LLC
Entity type:Organization
Organization Name:WAGDY M HABASHY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGDY
Authorized Official - Middle Name:MOURIN
Authorized Official - Last Name:HABASHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-564-6296
Mailing Address - Street 1:31 DOW RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1800
Mailing Address - Country:US
Mailing Address - Phone:860-564-6296
Mailing Address - Fax:860-230-0446
Practice Address - Street 1:31 DOW RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1800
Practice Address - Country:US
Practice Address - Phone:860-564-6296
Practice Address - Fax:860-230-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0362631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty