Provider Demographics
NPI:1578551966
Name:HAZRATJI, MOHAMMAD SYED ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SYED ALI
Last Name:HAZRATJI
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 1:15 HOSPITAL DR
Mailing Address - Street 2:STE 401
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6606
Mailing Address - Country:US
Mailing Address - Phone:413-534-5135
Mailing Address - Fax:413-534-3328
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:STE 401
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6606
Practice Address - Country:US
Practice Address - Phone:413-534-5135
Practice Address - Fax:413-534-3328
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA473992084N0400X
CT0227452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00114940OtherRAILROAD MEDICARE
CT130000577OtherMEDICARE OF CT
MA0151394Medicaid
MAM17327OtherBLUESHIELD OF MA
CT1227453Medicaid
MA0151394Medicaid
MAP00114940OtherRAILROAD MEDICARE