Basic Information
| Provider Information | |||||||||
| NPI: | 1558373969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARD | ||||||||
| FirstName: | MIRIAM | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 890291 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282890291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282774810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 90 SOUTHSIDE AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282774810 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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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 | 207Q00000X | 29596 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 13576 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 200500053 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5914395 | 05 | NC | MEDICAID |