Provider Demographics
NPI:1053389395
Name:HARDY, STEPHEN CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CLAYTON
Last Name:HARDY
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:888-644-3248
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST YAW 6
Practice Address - Street 2:PEDIATRIC GI AND NUTRITION ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71020208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3085830Medicaid
MAJ10861OtherBCBS MA
MA726013OtherTUFTS HEALTH PLAN
MA726013OtherTUFTS HEALTH PLAN
E78543Medicare UPIN