MEDICARE: DR. MATTHEW T. HAZELBAKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35.072181	OH
2	207V00000X	Obstetrics & Gynecology Physician	35.072181	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235134222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW T. HAZELBAKER MD

Provider Business Mailing Address
First Line	:	150 MOREY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1646
Country	:	US
Telephone Number	:	937-644-2541
Fax Number	:	937-642-7535

Provider Business Practice Location Address
First Line	:	150 MOREY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1646
Country	:	US
Telephone Number	:	937-644-2541
Fax Number	:	937-642-7535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/13/2026

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