Provider Demographics
NPI:1407835275
Name:HARWARD, MARY PEACOCK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PEACOCK
Last Name:HARWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 W CHAPMAN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2862
Mailing Address - Country:US
Mailing Address - Phone:714-532-4915
Mailing Address - Fax:714-532-9719
Practice Address - Street 1:1234 W CHAPMAN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2862
Practice Address - Country:US
Practice Address - Phone:714-532-4915
Practice Address - Fax:714-532-9719
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50028207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD89313Medicare UPIN