Provider Demographics
NPI:1225015324
Name:HARDEN, WESLEY RENNIE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:RENNIE
Last Name:HARDEN
Suffix:III
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 1:2015 SPRING RD
Mailing Address - Street 2:STE 300
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3944
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:
Practice Address - Street 1:14 PIDGEON HILL DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6133
Practice Address - Country:US
Practice Address - Phone:571-313-3771
Practice Address - Fax:571-313-3775
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019142E202K00000X
VA0101256377202K00000X, 208600000X
AL10249208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160255YCYYMedicare UPIN
VAVVE272AMedicare UPIN
VA420969YAY8Medicare PIN
VAG01618Medicare PIN
PA194873Medicare UPIN
VAC10441Medicare UPIN