Provider Demographics
NPI:1689629974
Name:HARDWICK, JOSEPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:HARDWICK
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 1:225 NOTTEARGENTA RD
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3111
Mailing Address - Country:US
Mailing Address - Phone:310-459-9965
Mailing Address - Fax:310-459-9965
Practice Address - Street 1:225 NOTTEARGENTA RD
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3111
Practice Address - Country:US
Practice Address - Phone:310-459-9965
Practice Address - Fax:310-459-9965
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34434207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344370Medicaid
CAHA34437FMedicare ID - Type Unspecified
CA00A344370Medicaid
CABA935YMedicare PIN
CABA935XMedicare PIN
CAWA34437RMedicare ID - Type Unspecified
CABA935ZMedicare PIN