Provider Demographics
NPI:1780034645
Name:HARDEN, JEREMY LAMONT
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:LAMONT
Last Name:HARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CREEK MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-6717
Mailing Address - Country:US
Mailing Address - Phone:804-839-6607
Mailing Address - Fax:804-271-6440
Practice Address - Street 1:3301 CREEK MEADOW CIR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-6717
Practice Address - Country:US
Practice Address - Phone:804-839-6607
Practice Address - Fax:804-271-6440
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT69883837343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)