Provider Demographics
NPI:1760522650
Name:HARDIN, JEFF (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:HARDIN
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-6380
Mailing Address - Fax:980-302-6385
Practice Address - Street 1:125 QUEENS RD STE 500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3512
Practice Address - Country:US
Practice Address - Phone:980-302-6380
Practice Address - Fax:980-302-6385
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72958207P00000X
AZ25965207P00000X
NC598842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A729580Medicaid
G77014Medicare UPIN
CA00A729580Medicaid