Provider Demographics
NPI:1740201573
Name:HAZEL, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:HAZEL
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:PO BOX 60318
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0318
Mailing Address - Country:US
Mailing Address - Phone:703-385-4707
Mailing Address - Fax:
Practice Address - Street 1:13350 FRANKLIN FARM ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171
Practice Address - Country:US
Practice Address - Phone:703-471-5300
Practice Address - Fax:701-471-4391
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040294207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6301622Medicaid
522420C95Medicare ID - Type Unspecified
0962280003Medicare NSC
VA6301622Medicaid