Provider Demographics
NPI:1659353043
Name:HARDY, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:HARDY
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 1:3580 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-698-1856
Mailing Address - Fax:703-207-0843
Practice Address - Street 1:3580 JOSEPH SIEWIWCK DRIVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-698-1856
Practice Address - Fax:703-207-0843
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037547208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010273340Medicaid
VA010273340Medicaid
VAG02282N14Medicare PIN