Healthcare Provider Details

I. General information

NPI: 1023123593
Provider Name (Legal Business Name): MARK ADAIR HARDY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 CENTER RD STE B
AVON OH
44011-1239
US

IV. Provider business mailing address

PO BOX 636643
CINCINNATI OH
45263-6643
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-4304
  • Fax: 440-960-4305
Mailing address:
  • Phone: 440-989-3801
  • Fax: 440-960-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-003101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: