Provider Demographics
NPI:1093703803
Name:HARDY, VIVIANA E (MD)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:E
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3059
Mailing Address - Fax:717-544-3638
Practice Address - Street 1:2110 HARRISBURG PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3059
Practice Address - Fax:717-544-3638
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD070265L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019038930001Medicaid
PA1527198OtherGATEWAY HEALTH PLAN
PA107748 4699OtherGEISINGER HEALTH PLAN
1086488OtherAETNA HMO
PA7046651OtherAETNA NON-HMO
PAH67527OtherHEALTH ASSURANCE
PA1398225OtherHIGHMARK BLUE SHIELD
PA20019291OtherAMERIHEALTH MERCY HEALTH
PA50008360OtherCAPITAL BLUE CROSS
PA50008360OtherCAPITAL BLUE CROSS
PAH67527Medicare UPIN