Healthcare Provider Details

I. General information

NPI: 1679790059
Provider Name (Legal Business Name): GEORGE E HARDY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 BRANCH AVE STE 6
PROVIDENCE RI
02904-1728
US

IV. Provider business mailing address

276 NORWOOD AVE
CRANSTON RI
02905-2712
US

V. Phone/Fax

Practice location:
  • Phone: 401-233-5055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12939
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12939
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: