NPIMap

Individual provider Active NPI

Waleed Hazem Ezzat, M.D.

  • Otolaryngology Physician
  • Boston, MA
National Provider Identifier
1821118837
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
249477 Issued in MA
Practice address
830 Harrison Ave Ste 1400
Boston, MA 02118-2905
Phone
(617) 638-8124
Fax
(617) 638-6424
NPI assigned
Mar 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery Physician 207YS0123X 249477 MA
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 249477 MA
Otolaryngology Physician 207Y00000X 249477 MA Primary

Addresses

Primary practice location

830 Harrison Ave Ste 1400
Boston, MA 02118-2905

Mailing address

960 Massachusetts Avenue
FL 2
Boston, MA 02118-2690

Other identifiers 3

IdentifierTypeStateIssuer
3125285MedicaidNH
0A1130100MedicaidCA
110090218AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111014000302 MA Practitioner - Otolaryngology 2668596107 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Wayne State University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bumc Otolaryngologic Foundation IncGroup PAC ID 2163409400, 28 clinicians

Practice addresses (Care Compare)

830 Harrison Ave
Suite 1400
Boston, MA 02118-2905
Phone (617) 638-8124

Hospital & facility affiliations

  • Boston Medical Center Hospital, Boston, MA, CCN 220031

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
113010CAMDGeneral Practice Dentistry
249477MAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bumc Otolaryngologic Foundation, Inc. Otolaryngology CurrentSince Sep 8, 2011 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients
The Regents of the University of California Past Accepting new patients

Locations

960 Massachusetts Ave
Ste 2
Boston, MA 02118

801 Albany St
Fl G
Roxbury, MA 02119

Interoperability endpoints

  • Direct secure messaging: wezzat10202@direct.bmc.masshiway.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1821118837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVENUE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 HARRISON AVE STE 1400",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182905",
            "telephone_number": "617-638-8124",
            "fax_number": "617-638-6424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZZAT",
        "first_name": "WALEED",
        "middle_name": "HAZEM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-31",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "MA",
            "license": "249477",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MA",
            "license": "249477",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MA",
            "license": "249477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3125285",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0A1130100",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110090218A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.