Healthcare Provider Details

I. General information

NPI: 1750681953
Provider Name (Legal Business Name): BRENT HARDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BRADDOCK AVE
BRADDOCK PA
15104-1856
US

IV. Provider business mailing address

501 BRADDOCK AVE
BRADDOCK PA
15104-1856
US

V. Phone/Fax

Practice location:
  • Phone: 412-636-5050
  • Fax: 412-271-2361
Mailing address:
  • Phone: 412-636-5050
  • Fax: 412-271-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD455461
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103055435
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: