Provider Demographics
NPI:1386641710
Name:HARDIN, GREGORY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
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 1:8141 S EMERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8560
Mailing Address - Country:US
Mailing Address - Phone:317-888-1051
Mailing Address - Fax:317-888-1591
Practice Address - Street 1:8141 S EMERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8560
Practice Address - Country:US
Practice Address - Phone:317-888-1051
Practice Address - Fax:317-888-1591
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036081A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100196580Medicaid
E90135Medicare UPIN
INM400056982Medicare PIN