Provider Demographics
NPI:1508894494
Name:BEAR, MICHELLE HAZEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HAZEL
Last Name:BEAR
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 1:230 LAUREL HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3634
Mailing Address - Country:US
Mailing Address - Phone:856-451-9595
Mailing Address - Fax:856-451-4130
Practice Address - Street 1:230 LAUREL HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3634
Practice Address - Country:US
Practice Address - Phone:856-451-9595
Practice Address - Fax:856-451-4130
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB079423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0087726Medicaid
I49400Medicare UPIN
098292L14Medicare ID - Type Unspecified