Provider Demographics
NPI:1316088552
Name:WEISSMAN, HAZEL FAYE (MD)
Entity type:Individual
Prefix:DR
First Name:HAZEL
Middle Name:FAYE
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HAZEL
Other - Middle Name:FAYE
Other - Last Name:SAMILOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4858
Mailing Address - Country:US
Mailing Address - Phone:724-816-0534
Mailing Address - Fax:
Practice Address - Street 1:1130 24TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4858
Practice Address - Country:US
Practice Address - Phone:724-816-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK52532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0697188Medicaid
PA0697188Medicaid
PAB33736Medicare UPIN