Provider Demographics
NPI:1649269440
Name:HARDY, SETH M (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:M
Last Name:HARDY
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 1:28 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5226
Mailing Address - Country:US
Mailing Address - Phone:207-622-4231
Mailing Address - Fax:207-623-1580
Practice Address - Street 1:28 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5226
Practice Address - Country:US
Practice Address - Phone:207-622-4231
Practice Address - Fax:207-623-1580
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0179482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431877999Medicaid
ME1730158734OtherANTHEM
ME1730158734OtherANTHEM