Provider Demographics
NPI:1780621466
Name:HARDISON, HAROLD HUNTLEY (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:HUNTLEY
Last Name:HARDISON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. CHRISTOPHER'S PEDIATRIC NEUROLOGY
Mailing Address - Street 2:3601 A STREET
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1095
Mailing Address - Country:US
Mailing Address - Phone:215-427-5470
Mailing Address - Fax:215-427-4393
Practice Address - Street 1:ST. CHRISTOPHER'S PEDIATRIC NEUROLOGY
Practice Address - Street 2:3601 A STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1095
Practice Address - Country:US
Practice Address - Phone:215-427-5470
Practice Address - Fax:215-427-4393
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027761E2084N0402X
NJ25MA048779002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010073830020Medicaid
PA143071Medicare ID - Type Unspecified
PA0010073830020Medicaid