Provider Demographics
NPI:1457318776
Name:HARDING, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:HARDING
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 1:1900 ELECTRIC RD
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7474
Mailing Address - Country:US
Mailing Address - Phone:540-772-3680
Mailing Address - Fax:540-772-3679
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:SUITE 1020
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-772-3680
Practice Address - Fax:540-772-3679
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457318776Medicaid
VA179616OtherANTHEM
VA010173523Medicaid
VA179616OtherANTHEM
VA1457318776Medicaid
I37132Medicare UPIN
VA00W448502Medicare ID - Type Unspecified
VA010173523Medicaid