Healthcare Provider Details

I. General information

NPI: 1134743511
Provider Name (Legal Business Name): WALEED AL-HARDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date: 01/18/2022
Reactivation Date: 06/27/2022

III. Provider practice location address

111 CLARA BARTON ST
DANSVILLE NY
14437-9503
US

IV. Provider business mailing address

111 CLARA BARTON ST
DANSVILLE NY
14437-9503
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number324438
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5765F
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: