Provider Demographics
NPI:1750380887
Name:BOWEN-WRIGHT, HAZEL E (MD)
Entity type:Individual
Prefix:DR
First Name:HAZEL
Middle Name:E
Last Name:BOWEN-WRIGHT
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 1:3022 JAVIER RD
Mailing Address - Street 2:SUITES 105G
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4645
Mailing Address - Country:US
Mailing Address - Phone:703-676-3433
Mailing Address - Fax:703-676-3438
Practice Address - Street 1:3022 JAVIER RD
Practice Address - Street 2:SUITES 105G
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4645
Practice Address - Country:US
Practice Address - Phone:703-676-3433
Practice Address - Fax:703-676-3438
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056768207RE0101X
VA0101235232207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
64524904OtherCAREFIRST
MD407289800Medicaid
64524905OtherCAREFIRST
0003OtherCAREFIRST
116536OtherJHHC
5388737OtherAETNA PPO
64524903OtherCAREFIRST
64524901OtherCAREFIRST
64524902OtherCAREFIRST
64524906OtherCAREFIRST
3945866OtherAETNA HMO
223918ZA84Medicare PIN
5388737OtherAETNA PPO
64524901OtherCAREFIRST
P00335971Medicare PIN