Basic Information
| Provider Information | |||||||||
| NPI: | 1093703803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | VIVIANA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 HARRISBURG PIKE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443059 | ||||||||
| FaxNumber: | 7175443638 | ||||||||
| Practice Location | |||||||||
| Address1: | 2110 HARRISBURG PIKE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443059 | ||||||||
| FaxNumber: | 7175443638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 08/18/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD070265L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0019038930001 | 05 | PA | MEDICAID | 1527198 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 107748 4699 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 1086488 | 01 | AETNA HMO | OTHER | 7046651 | 01 | PA | AETNA NON-HMO | OTHER | H67527 | 01 | PA | HEALTH ASSURANCE | OTHER | 1398225 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 20019291 | 01 | PA | AMERIHEALTH MERCY HEALTH | OTHER | 50008360 | 01 | PA | CAPITAL BLUE CROSS | OTHER |