Provider Demographics
NPI:1255543179
Name:HARDING, AMANDA LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNNE
Last Name:HARDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LYNNE
Other - Last Name:GLASSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4650 SIGNAL TREE DR UNIT 400
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-4902
Mailing Address - Country:US
Mailing Address - Phone:970-812-9927
Mailing Address - Fax:
Practice Address - Street 1:4650 SIGNAL TREE DR UNIT 400
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4902
Practice Address - Country:US
Practice Address - Phone:970-812-9927
Practice Address - Fax:970-999-8655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083796208000000X
CO50141208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70650780Medicaid
COCOAAA2735Medicare UPIN