Provider Demographics
NPI:1053378273
Name:HARDIN, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:HARDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PINE CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5357
Mailing Address - Country:US
Mailing Address - Phone:423-434-0014
Mailing Address - Fax:423-434-0014
Practice Address - Street 1:111 PINE CT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5357
Practice Address - Country:US
Practice Address - Phone:423-434-0014
Practice Address - Fax:423-434-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18028207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3029785Medicaid
NH30209290Medicaid
TN3029785Medicare PIN
VA010869C82Medicare PIN
NH30209290Medicaid
NHP00799473Medicare PIN
NH001436201Medicare PIN