1013079862 NPI number — DR. LISA MARIE HATZOS MD

Table of content: DR. LISA MARIE HATZOS MD (NPI 1013079862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013079862 NPI number — DR. LISA MARIE HATZOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATZOS
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAZZARA-HATZOS
Provider Other First Name:
LISA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013079862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 ROCKINGHAM ROAD
Provider Second Line Business Mailing Address:
SUITE 103 ELLIOT PEAK INTERNAL MEDICINE AT WINDHAM
Provider Business Mailing Address City Name:
WINDHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-890-0266
Provider Business Mailing Address Fax Number:
603-890-0267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 ROCKINGHAM ROAD
Provider Second Line Business Practice Location Address:
SUITE 103 ELLIOT PEAK INTERNAL MEDICINE AT WINDHAM
Provider Business Practice Location Address City Name:
WINDHAM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-890-0266
Provider Business Practice Location Address Fax Number:
603-890-0267
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  NH10943 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 10943 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30212498 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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