Provider Demographics
NPI:1457332553
Name:HAZLITT, HENRY ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:ANDREW
Last Name:HAZLITT
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 1:455 PINELLAS STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3356
Mailing Address - Country:US
Mailing Address - Phone:727-445-1911
Mailing Address - Fax:727-445-1986
Practice Address - Street 1:455 PINELLAS STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3356
Practice Address - Country:US
Practice Address - Phone:727-445-1911
Practice Address - Fax:727-445-1986
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66184207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375822200Medicaid
B23369Medicare UPIN
FL375822200Medicaid