Healthcare Provider Details

I. General information

NPI: 1487662748
Provider Name (Legal Business Name): TIMOTHY JOSEPH HARDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 HOLLAND RD SUITE 101
VIRGINIA BEACH VA
23452-2859
US

IV. Provider business mailing address

3720 HOLLAND RD SUITE 101
VIRGINIA BEACH VA
23452-2859
US

V. Phone/Fax

Practice location:
  • Phone: 757-463-1234
  • Fax: 757-463-0453
Mailing address:
  • Phone: 757-463-1234
  • Fax: 757-463-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101043703
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: