Provider Demographics
NPI:1366576522
Name:IAN A. HARDING MD PC
Entity type:Organization
Organization Name:IAN A. HARDING MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-756-2020
Mailing Address - Street 1:45 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-0000
Mailing Address - Country:US
Mailing Address - Phone:508-756-2020
Mailing Address - Fax:508-756-0705
Practice Address - Street 1:45 OAK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-0000
Practice Address - Country:US
Practice Address - Phone:508-756-2020
Practice Address - Fax:508-756-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE01995Medicaid