Healthcare Provider Details

I. General information

NPI: 1609161959
Provider Name (Legal Business Name): JOHN WESLEY HARDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEACONESS ROAD, W-CC2 BIDMC DEPT OF EMERGENCY MEDICINE
BOSTON MA
02215-5321
US

IV. Provider business mailing address

1 DEACONESS ROAD, W-CC2 BIDMC DEPT OF EMERGENCY MEDICINE
BOSTON MA
02215-5321
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-2339
  • Fax: 617-754-2350
Mailing address:
  • Phone: 617-754-2339
  • Fax: 617-754-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number258655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: