Individual
MR. SAMUEL HAZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1859 SAVAGE RD, CHARLESTON, SC 29407-4726
(843) 723-2835
(843) 722-8948
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2454
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
10048
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100483
—
SC
01
—
5551
MEDICARE GROUP #
SC
01
—
GP4953
MEDICAID GROUP
SC
01
—
P00638310
RAILROAD MEDICARE
SC
01
—
P00879497
RR MEDICARE RSFP
—
Enumeration date
09/01/2006
Last updated
02/24/2011
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