Healthcare Provider Details

I. General information

NPI: 1073508602
Provider Name (Legal Business Name): JEREMY LEONARD HARDISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CROOKED CREEK PKWY
DURHAM NC
27713-8505
US

IV. Provider business mailing address

121 MEDICAL CENTER DR
BRUNSWICK ME
04011-2653
US

V. Phone/Fax

Practice location:
  • Phone: 919-385-3000
  • Fax: 919-576-8822
Mailing address:
  • Phone: 434-947-3963
  • Fax: 434-947-5935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2003-00611
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD26608
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101239901
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number200300611
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: