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General NPI Number Information
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NPI Number | 1073508602
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Entity Type | Individual
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Provider Name | JEREMY LEONARD HARDISON M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 234 CROOKED CREEK PKWY
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City | DURHAM
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State | NC
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Zip | 27713-8505
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Country | US
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Telephone | 919-385-3000
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Fax | 919-576-8822
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Provider Business Mailing Address
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Address Line | 121 MEDICAL CENTER DR
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City | BRUNSWICK
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State | ME
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Zip | 04011-2653
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Country | US
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Telephone | 434-947-3963
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Fax | 434-947-5935
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2003-00611
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD26608
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 0101239901
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 200300611
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License Number State | NC
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