Healthcare Provider Details

I. General information

NPI: 1174183164
Provider Name (Legal Business Name): JAMES BAUSS HARDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES B HARDING

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 GODWIN BLVD STE 100
SUFFOLK VA
23434-8501
US

IV. Provider business mailing address

2760 GODWIN BLVD STE 100
SUFFOLK VA
23434-8501
US

V. Phone/Fax

Practice location:
  • Phone: 757-983-8650
  • Fax:
Mailing address:
  • Phone: 757-983-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101275637
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1401164840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: