Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 226420 | MA |
NPI | 1417170713 |
---|---|
Provider Name | Dr. Melissa Mckirdy Hazen |
First Address | Boston, MA 02118-1610 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 13/01/2010 |