=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659337400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW EVAN HARDIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2006
-----------------------------------------------------
Last Update Date | 03/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7690 DISCOVERY DR
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45069-6542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-584-7425
-----------------------------------------------------
Fax | 513-475-7453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 636256 CENTRAL CREDENTIALING
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45263-6256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-585-5507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 35-073396
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 35-073396
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------