Healthcare Provider Details

I. General information

NPI: 1750380887
Provider Name (Legal Business Name): HAZEL E BOWEN-WRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 JAVIER RD SUITES 105G
FAIRFAX VA
22031-4645
US

IV. Provider business mailing address

3022 JAVIER RD SUITES 105G
FAIRFAX VA
22031-4645
US

V. Phone/Fax

Practice location:
  • Phone: 703-676-3433
  • Fax: 703-676-3438
Mailing address:
  • Phone: 703-676-3433
  • Fax: 703-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0056768
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101235232
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: