Provider Demographics
NPI:1487016648
Name:HAZLETT-OBRIEN, COLLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:HAZLETT-OBRIEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 ROYAL HUNT WAY
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7616
Mailing Address - Country:US
Mailing Address - Phone:215-694-5656
Mailing Address - Fax:
Practice Address - Street 1:685 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2426
Practice Address - Country:US
Practice Address - Phone:717-735-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020511207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty