Provider Demographics
NPI:1790891596
Name:HAZNECI, SINA S (MD)
Entity Type:Individual
Prefix:
First Name:SINA
Middle Name:S
Last Name:HAZNECI
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 21610
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-0610
Mailing Address - Country:US
Mailing Address - Phone:800-923-7963
Mailing Address - Fax:
Practice Address - Street 1:615 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2001
Practice Address - Country:US
Practice Address - Phone:419-734-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-6761-H2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0766149Medicaid
OH0638831Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMB
OH0766149Medicaid