Provider Demographics
NPI:1023123593
Name:HARDY, MARK ADAIR (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ADAIR
Last Name:HARDY
Suffix:
Gender:M
Credentials:DPM
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 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:1480 CENTER RD
Practice Address - Street 2:STE B
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1239
Practice Address - Country:US
Practice Address - Phone:440-960-4304
Practice Address - Fax:440-960-4305
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2226246Medicaid
HA4047051Medicare ID - Type Unspecified
OH2226246Medicaid