1588839682 NPI number — PAUL ANDREW HARDISON DMD

Table of content: PAUL ANDREW HARDISON DMD (NPI 1588839682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588839682 NPI number — PAUL ANDREW HARDISON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDISON
Provider First Name:
PAUL
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588839682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HUNTINGSON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-864-2877
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRWIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-4326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-864-2877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS022290L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0009067 . This is a "UPMC DORAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010038760001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135265593574 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".