Provider Demographics
NPI:1881617470
Name:HARDIE, GREGORY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEVEN
Last Name:HARDIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:145 KIMEL PARK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6983
Mailing Address - Country:US
Mailing Address - Phone:336-768-3212
Mailing Address - Fax:336-768-9019
Practice Address - Street 1:145 KIMEL PARK DR STE 120
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6983
Practice Address - Country:US
Practice Address - Phone:336-768-3212
Practice Address - Fax:336-768-9019
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC26933207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1373TOtherBCBS
P00207470OtherRR MEDICARE
NC891073HMedicaid
NC1373TOtherBCBS
NC891073HMedicaid