Provider Demographics
NPI:1740350883
Name:HARNED, MAX A (MD FAAP PHD)
Entity type:Individual
Prefix:MR
First Name:MAX
Middle Name:A
Last Name:HARNED
Suffix:
Gender:M
Credentials:MD FAAP PHD
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Mailing Address - Street 1:ONE MEMORIAL DRIVE
Mailing Address - Street 2:HARNED MEMORIAL MEDICAL CLINIC INC
Mailing Address - City:BRUCETON MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26525-9500
Mailing Address - Country:US
Mailing Address - Phone:304-379-2114
Mailing Address - Fax:304-379-7929
Practice Address - Street 1:ONE MEMORIAL DRIVE
Practice Address - Street 2:RT 26 NORTH
Practice Address - City:BRUCETON MILLS
Practice Address - State:WV
Practice Address - Zip Code:26525-9500
Practice Address - Country:US
Practice Address - Phone:304-379-2114
Practice Address - Fax:304-379-7929
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV12679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1066800OtherWORKERS COMPENSATION
111038OtherCARE LINK
171900OtherBLACK LUNG
WV0056848000Medicaid
WV0056848000Medicaid
A72242Medicare UPIN