Provider Demographics
NPI:1609161959
Name:HARDIN, JOHN WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
Last Name:HARDIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1 DEACONESS ROAD, W-CC2
Mailing Address - Street 2:BIDMC DEPT OF EMERGENCY MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5321
Mailing Address - Country:US
Mailing Address - Phone:617-754-2339
Mailing Address - Fax:617-754-2350
Practice Address - Street 1:1 DEACONESS ROAD, W-CC2
Practice Address - Street 2:BIDMC DEPT OF EMERGENCY MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5321
Practice Address - Country:US
Practice Address - Phone:617-754-2339
Practice Address - Fax:617-754-2350
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2020-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA258655207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110099635AMedicaid