Provider Demographics
NPI:1699763912
Name:HAZEN, RUTH A (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:HAZEN
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 1:628 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2340
Mailing Address - Country:US
Mailing Address - Phone:781-599-1998
Mailing Address - Fax:781-599-1221
Practice Address - Street 1:628 SALEM ST
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2340
Practice Address - Country:US
Practice Address - Phone:781-599-1998
Practice Address - Fax:781-599-1221
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA46056208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3011933Medicaid
706807OtherTUFTS
200492OtherHARVARD/PILG
B10083501OtherCIGNA
J05790OtherBCBS
200492OtherHARVARD/PILG