Provider Demographics
NPI:1174081343
Name:HARDEN, WINSTON FREDERICK
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:FREDERICK
Last Name:HARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 DARK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:UPPERCO
Mailing Address - State:MD
Mailing Address - Zip Code:21155-9358
Mailing Address - Country:US
Mailing Address - Phone:443-547-3303
Mailing Address - Fax:
Practice Address - Street 1:16301 DARK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:UPPERCO
Practice Address - State:MD
Practice Address - Zip Code:21155-9358
Practice Address - Country:US
Practice Address - Phone:443-547-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer