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Gordon Loughlin Hazen

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as GORDON HAZEN.

Based on the most recent information from CMS, provider Gordon Loughlin Hazen is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 2:35 PM.

Profile Details

Provider ID
1689600298
Provider Type
Individual
Full Name
Hazen, Gordon Loughlin
Credential
PA

Gender
Male
Sole Proprietor
No
Enumeration Date
6/24/2006
Last Updated
9/5/2025

Contact Information

Practice Location

22 Bramhall St, Portland, ME 04102-3134

(207) 662-0111

Unlisted Fax

Mailing Location

22 Bramhall St, Portland, ME 04102-3134

(207) 662-0111

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA2928 Maine
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 004258 New York

Gordon Loughlin Hazen

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Nason, Joshua

Amdahl, Lola Louise

Shoos, Connor John

Kenney, Julianna Cole

Pearson, Melinda M

King, Abby

Hoff, James Robert

Lyon, Devin Judith

Clancy, Brendan Ciampa

Lebourdais, Laura Ann