Provider Demographics
NPI:1265480370
Name:HAZEN, GALE A (MD)
Entity Type:Individual
Prefix:DR
First Name:GALE
Middle Name:A
Last Name:HAZEN
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 1:5319 HOAG DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1494
Mailing Address - Country:US
Mailing Address - Phone:440-930-6015
Mailing Address - Fax:440-930-6094
Practice Address - Street 1:5319 HOAG DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1494
Practice Address - Country:US
Practice Address - Phone:440-930-6015
Practice Address - Fax:440-930-6094
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042917H207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821543Medicaid
OH0690582Medicare PIN
OHD25946Medicare UPIN