Provider Demographics
NPI:1558415679
Name:HAZZARD, MARY (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HAZZARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:213 REECEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1574
Mailing Address - Country:US
Mailing Address - Phone:610-383-8589
Mailing Address - Fax:610-383-5676
Practice Address - Street 1:1015 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:JENNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19390
Practice Address - Country:US
Practice Address - Phone:610-869-1000
Practice Address - Fax:610-869-1246
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN180476L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
022222Medicare ID - Type Unspecified