Healthcare Provider Details

I. General information

NPI: 1801931969
Provider Name (Legal Business Name): LESLIE COLT HARDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CHURCH STREET
JAY ME
04239
US

IV. Provider business mailing address

12 CHURCH STREET
JAY ME
04239
US

V. Phone/Fax

Practice location:
  • Phone: 207-897-2521
  • Fax: 207-897-3948
Mailing address:
  • Phone: 207-897-2521
  • Fax: 207-897-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number9446
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: