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General NPI Number Information
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NPI Number | 1538139779
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Entity Type | Individual
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Provider Name | MARK HAZEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 2209 S STERLING ST SUITE 600
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City | MORGANTON
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State | NC
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Zip | 28655-4091
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Country | US
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Telephone | 704-444-4244
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Fax | 704-347-5261
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Provider Business Mailing Address
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Address Line | PO BOX 601067
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City | CHARLOTTE
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State | NC
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Zip | 28260-1067
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Country | US
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Telephone | 704-444-4244
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Fax | 704-347-5261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01039253
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2011-00879
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License Number State | NC
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