Provider Demographics
NPI:1720034887
Name:BLUESTEIN, HAZEL M (MD)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:M
Last Name:BLUESTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3593 ARCOLA RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3460
Mailing Address - Country:US
Mailing Address - Phone:610-613-5537
Mailing Address - Fax:
Practice Address - Street 1:450 CRESSON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19456
Practice Address - Country:US
Practice Address - Phone:610-728-6100
Practice Address - Fax:610-728-6071
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027181E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA223701OtherALLIANCE/OPT CHC (MAMSI)
PA350650OtherPHCS
PA0019559OtherAETNA HMO
PA4100277OtherAETNA PPO
PA0047233000OtherIBC - PC/KHPE
PA0916258OtherCIGNA HMO/PPO
PA10923280OtherCAQH ID#
PA080062760OtherRRM
PA102684OtherHIGHMARK BLUE SHIELD
PA0047233000OtherAMERIHEALTH/INTERCOUNTY
PA1017865OtherKEYSTONE MERCY
PA10923280OtherCAQH ID#
PA102684HMPMedicare ID - Type UnspecifiedHGSA