Provider Demographics
NPI:1477610228
Name:BEN HARDIN, MD, PA
Entity Type:Organization
Organization Name:BEN HARDIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-739-8164
Mailing Address - Street 1:2901 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2982
Mailing Address - Country:US
Mailing Address - Phone:910-739-8164
Mailing Address - Fax:910-738-7731
Practice Address - Street 1:2901 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2982
Practice Address - Country:US
Practice Address - Phone:910-739-8164
Practice Address - Fax:910-738-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21788261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8939356Medicaid
NC8939356Medicaid
E00435Medicare UPIN