=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285640722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS J. HARDY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 S MAIN ST
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-799-2100
-----------------------------------------------------
Fax | 434-799-2260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 212 S MAIN ST SUITE 4
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-799-8398
-----------------------------------------------------
Fax | 434-799-1415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 0101030846
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------