Provider Demographics
NPI:1407590698
Name:PRINCE-WANNAH, HAZEL-ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAZEL-ANN
Middle Name:
Last Name:PRINCE-WANNAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HAZEL-ANN
Other - Middle Name:
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:450 CLARKSON AVENUE
Mailing Address - Street 2:DEPT OF MEDICINE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-245-3408
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVENUE
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-245-3408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program