Provider Demographics
NPI:1215972195
Name:HAZRA, SANDRA V (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:V
Last Name:HAZRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-844-3951
Mailing Address - Fax:440-722-8396
Practice Address - Street 1:5133 RIDGE RD STE 5
Practice Address - Street 2:SEIDMAN CANCER CTR
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8078
Practice Address - Country:US
Practice Address - Phone:440-844-3951
Practice Address - Fax:440-722-8396
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD175021207RH0003X
OH35044095207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0423581Medicaid
341660197AOtherSUMMACARE
OH000000134345OtherANTHEM BCBS
OH000000134345OtherANTHEM BCBS