MEDICARE: INTERNAL MEDICINE ASSOC OF HAZELTON INC

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	207R00000X	Internal Medicine Physician

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	:	1922114248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOC OF HAZELTON INC

Provider Business Mailing Address
First Line	:	1090 N CHURCH ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-1446
Country	:	US
Telephone Number	:	570-459-1485
Fax Number	:	570-459-6354

Provider Business Practice Location Address
First Line	:	1090 N CHURCH ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-1446
Country	:	US
Telephone Number	:	570-459-1485
Fax Number	:	570-459-6354

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANCISCO A GAZEK
Credential	:	MD
Telephone Number	:	570-459-1485

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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