Provider Demographics
NPI:1912952748
Name:HAZRA, MEGHAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:M
Last Name:HAZRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEGHAN
Other - Middle Name:M
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20005 FRAZIER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1502
Mailing Address - Country:US
Mailing Address - Phone:216-609-3599
Mailing Address - Fax:
Practice Address - Street 1:29160 CENTER RIDGE RD
Practice Address - Street 2:SUITE M
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5225
Practice Address - Country:US
Practice Address - Phone:440-835-6996
Practice Address - Fax:440-808-9738
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106466207V00000X
OH34-011505207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL95529Medicare PIN
ILH75459Medicare UPIN