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General NPI Number Information
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NPI Number | 1659475366
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Entity Type | Individual
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Provider Name | DERYA BORA HAZAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 2100 DORCHESTER AVE SUITE 2204
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City | DORCHESTER CENTER
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State | MA
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Zip | 02124-5615
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Country | US
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Telephone | 617-739-2100
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Fax | 617-296-4330
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Provider Business Mailing Address
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Address Line | 31 PINE ST STE 204
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City | NORFOLK
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State | MA
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Zip | 02056-1680
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Country | US
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Telephone | 617-739-2100
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Fax | 617-296-4330
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 78328
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License Number State | MA
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