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1588641880

NPI Code Detail

MEDICARE: DR. LETITIA MARIE HAZEL MD

MEDICARE: DR. LETITIA MARIE HAZEL 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	207QA0401X	Addiction Medicine (Family Medicine) Physician	200101342	NC
2	207Q00000X	Family Medicine Physician	200101342	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00192377	OTHER	NC	RR MC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	130G4	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1588641880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETITIA MARIE HAZEL MD

Provider Business Mailing Address
First Line	:	PO BOX 696
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443
Country	:	US
Telephone Number	:	910-791-6767
Fax Number	:	910-791-8890

Provider Business Practice Location Address
First Line	:	2101 GARNER RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-0114
Country	:	US
Telephone Number	:	919-787-6131
Fax Number	:	919-571-2932

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	12/18/2024

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Directions to “ DR. LETITIA MARIE HAZEL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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