Provider Demographics
NPI:1073825535
Name:HAZELL, RHONDA LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:LYNN
Last Name:HAZELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PEAR ST
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1922
Mailing Address - Country:US
Mailing Address - Phone:856-912-2165
Mailing Address - Fax:215-951-1772
Practice Address - Street 1:900 PEAR ST
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-1922
Practice Address - Country:US
Practice Address - Phone:856-912-2165
Practice Address - Fax:215-951-1772
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00MD2513213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine