Healthcare Provider Details

I. General information

NPI: 1669449351
Provider Name (Legal Business Name): JEFFREY A HARWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 12/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 W MAIN ST
NEW LONDON OH
44851-1018
US

IV. Provider business mailing address

187 W MAIN ST
NEW LONDON OH
44851-1018
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-4357
  • Fax: 419-929-0814
Mailing address:
  • Phone: 419-929-4357
  • Fax: 419-929-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35056103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: