Healthcare Provider Details

I. General information

NPI: 1487016648
Provider Name (Legal Business Name): COLLEEN HAZLETT-OBRIEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 GOOD DR
LANCASTER PA
17601-2426
US

IV. Provider business mailing address

339 ROYAL HUNT WAY
LITITZ PA
17543-7616
US

V. Phone/Fax

Practice location:
  • Phone: 717-735-3131
  • Fax:
Mailing address:
  • Phone: 215-694-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS020511
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: