Healthcare Provider Details

I. General information

NPI: 1164458121
Provider Name (Legal Business Name): BRIAN A HAZEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD PHYSICIAN BILLING
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

3300 GALLOWS RD PHYSICIAN BILLING
FALLS CHURCH VA
22042-3307
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-1110
  • Fax: 703-776-2917
Mailing address:
  • Phone: 703-776-1110
  • Fax: 703-776-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2018-03045
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101053721
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: