Provider Demographics
NPI:1558374249
Name:HARKRADER, EDWARD REX SR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:REX
Last Name:HARKRADER
Suffix:SR
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 1:101 WOOLFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093
Mailing Address - Country:US
Mailing Address - Phone:540-967-2202
Mailing Address - Fax:540-967-1676
Practice Address - Street 1:101 WOOLFOLK AVE
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093
Practice Address - Country:US
Practice Address - Phone:540-967-2202
Practice Address - Fax:540-967-1676
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5613604Medicaid
VAF57127Medicare UPIN