Provider Demographics
NPI:1386131357
Name:IRIMPAN, HAZEL J (MD)
Entity type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:J
Last Name:IRIMPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HITCHCOCK WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HITCHCOCK WAY
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-629-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21027207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program