Provider Demographics
NPI:1801836069
Name:HARDIN, DAVID BURTON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BURTON
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 1:635 S EARL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3603
Mailing Address - Country:US
Mailing Address - Phone:765-838-8208
Mailing Address - Fax:765-838-8207
Practice Address - Street 1:8355 ROCKVILLE RD STE 120
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-2722
Practice Address - Country:US
Practice Address - Phone:317-429-0061
Practice Address - Fax:317-222-1953
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039780A208D00000X, 208100000X, 207R00000X
TN44907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100180760AMedicaid
KY6487340900Medicaid
IN534450Medicare PIN
E45624Medicare UPIN
TN3041801Medicare PIN
VA016694W82Medicare PIN