Provider Demographics
NPI:1902887862
Name:HABIB, MARCELLE G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLE
Middle Name:G
Last Name:HABIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCELLE
Other - Middle Name:G
Other - Last Name:HABIB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1020 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3423
Mailing Address - Country:US
Mailing Address - Phone:727-461-7730
Mailing Address - Fax:
Practice Address - Street 1:1020 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3423
Practice Address - Country:US
Practice Address - Phone:727-461-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22519208000000X
FLME66844208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376523700Medicaid