Provider Demographics
NPI:1659475366
Name:HAZAR, DERYA BORA (MD)
Entity Type:Individual
Prefix:
First Name:DERYA
Middle Name:BORA
Last Name:HAZAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:31 PINE ST
Mailing Address - Street 2:STE 204
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1680
Mailing Address - Country:US
Mailing Address - Phone:617-739-2100
Mailing Address - Fax:617-296-4330
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:SUITE 2204
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-739-2100
Practice Address - Fax:617-296-4330
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2017-07-28
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Provider Licenses
StateLicense IDTaxonomies
MA78328207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA02124Medicare UPIN