Basic Information
Provider Information | |||||||||
NPI: | 1881897205 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HABEEB | ||||||||
FirstName: | MURTUZA | ||||||||
MiddleName: | H | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 789 CENTRAL AVENUE | ||||||||
Address2: |   | ||||||||
City: | DOVER | ||||||||
State: | NH | ||||||||
PostalCode: | 038202526 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035164265 | ||||||||
FaxNumber: | 6037402173 | ||||||||
Practice Location | |||||||||
Address1: | 19 OLD ROLLINSFORD ROAD | ||||||||
Address2: | BUILDING B | ||||||||
City: | DOVER | ||||||||
State: | NH | ||||||||
PostalCode: | 038202827 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6035164265 | ||||||||
FaxNumber: | 6037402173 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/06/2007 | ||||||||
LastUpdateDate: | 03/11/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 036116332 | IL | N |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | LT-3493 | NH | Y |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
ID | Type | State | Issuer | Description | P01116488 | 01 | NH | RAILROAD MEDICARE | OTHER | 3075555 | 05 | NH |   | MEDICAID |