Healthcare Provider Details

I. General information

NPI: 1285638510
Provider Name (Legal Business Name): GLENN R HARDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 IDLEWILD AVE
EASTON MD
21601-3824
US

IV. Provider business mailing address

510 IDLEWILD AVE STE 200
EASTON MD
21601-3883
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-8226
  • Fax: 410-820-8405
Mailing address:
  • Phone: 410-820-8226
  • Fax: 410-820-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0029690
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: