Healthcare Provider Details

I. General information

NPI: 1699763912
Provider Name (Legal Business Name): RUTH A HAZEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 SALEM ST
LYNNFIELD MA
01940-2340
US

IV. Provider business mailing address

628 SALEM ST
LYNNFIELD MA
01940-2340
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-1998
  • Fax: 781-599-1221
Mailing address:
  • Phone: 781-599-1998
  • Fax: 781-599-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA46056
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: