Healthcare Provider Details

I. General information

NPI: 1699769745
Provider Name (Legal Business Name): ANDREW J HARDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 11/27/2023
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SUNRISE VALLEY DR SUITE 700
RESTON VA
20191-5300
US

IV. Provider business mailing address

PO BOX 791128
BALTIMORE MD
21279-1128
US

V. Phone/Fax

Practice location:
  • Phone: 703-834-1473
  • Fax: 703-318-7463
Mailing address:
  • Phone: 703-391-2030
  • Fax: 703-273-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101048758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: