Provider Demographics
NPI:1417170713
Name:HAZEN, MELISSA MCKIRDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MCKIRDY
Last Name:HAZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:MCKIRDY
Other - Last Name:HAZEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:20 UPTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1610
Mailing Address - Country:US
Mailing Address - Phone:617-797-6700
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:671-355-6117
Practice Address - Fax:617-730-0249
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2264202080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology