Basic Information
| Provider Information | |||||||||
| NPI: | 1982688743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDAWAY | ||||||||
| FirstName: | ALFRED | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | BLAKELY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184472504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703074225 | ||||||||
| FaxNumber: | 5703074226 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | BLAKELY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184472504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703074225 | ||||||||
| FaxNumber: | 5703074226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD038075E | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1079954 | 05 | PA | MEDICAID |