Provider Demographics
NPI:1386633659
Name:CHILDRESS HAZEN, LAURA Z (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:Z
Last Name:CHILDRESS HAZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 REEDSDALE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-2109
Mailing Address - Country:US
Mailing Address - Phone:412-323-8026
Mailing Address - Fax:412-323-4507
Practice Address - Street 1:330 S 9TH ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1266
Practice Address - Country:US
Practice Address - Phone:412-488-4040
Practice Address - Fax:412-488-4932
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067379L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
068690OtherHIGHMARK
PA0018174180003Medicaid
H23780Medicare UPIN
PA041366Medicare ID - Type Unspecified