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General NPI Number Information
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NPI Number | 1245423086
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Entity Type | Individual
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Provider Name | GLENN C HARDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 332 WASHINGTON ST
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City | WELLESLEY
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State | MA
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Zip | 02481-6219
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Country | US
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Telephone | 781-899-7092
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Fax |
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Provider Business Mailing Address
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Address Line | 15 RIPEY LANE
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City | WESTON
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State | MA
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Zip | 02493
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Country | US
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Telephone | 781-899-7092
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Fax |
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 48717
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License Number State | MA
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