Provider Demographics
NPI:1154302412
Name:HARDY, JAMES THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:HARDY
Suffix:
Gender:M
Credentials:DO
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 71-4828
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0001
Mailing Address - Country:US
Mailing Address - Phone:937-558-0200
Mailing Address - Fax:937-558-0201
Practice Address - Street 1:165 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-8472
Practice Address - Country:US
Practice Address - Phone:937-558-0200
Practice Address - Fax:937-558-0201
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330301Medicaid
OH3601331OtherMEDICARE GROUP NUMBER
E01019Medicare UPIN
OH2330301Medicaid