Provider Demographics
NPI:1497744734
Name:HAZRA, ANUPINDER S (MD)
Entity Type:Individual
Prefix:
First Name:ANUPINDER
Middle Name:S
Last Name:HAZRA
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-593-5500
Mailing Address - Fax:216-844-5522
Practice Address - Street 1:3999 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6046
Practice Address - Country:US
Practice Address - Phone:216-593-5500
Practice Address - Fax:216-844-5522
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010585842085R0202X
OH35-1236372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200484000Medicaid
INI15026Medicare UPIN
IN211520IMedicare PIN
IN200484000Medicaid