Provider Demographics
NPI:1245536192
Name:HAZARD, PAMELA W (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:W
Last Name:HAZARD
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 1:633 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-4000
Mailing Address - Country:US
Mailing Address - Phone:847-491-2151
Mailing Address - Fax:847-467-1193
Practice Address - Street 1:633 EMERSON ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-4000
Practice Address - Country:US
Practice Address - Phone:847-491-2151
Practice Address - Fax:847-467-1193
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360822722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry