Provider Demographics
NPI:1104807643
Name:HARDIE, HEATHER S (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:S
Last Name:HARDIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2500
Mailing Address - Fax:
Practice Address - Street 1:211 PARK ST
Practice Address - Street 2:STURDY MEMORIAL HOSPITAL
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3143
Practice Address - Country:US
Practice Address - Phone:508-236-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA793262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3140277OtherTRICARE
MAJ30738OtherBLUE CARE ELECT
MA04-3140277OtherHCVM FIRST HEALTH
MA300120369OtherRAILROAD MEDICARE
MA737695OtherTUFTS HEALTH PLAN
MAJ30738OtherHMO BLUE
MAP00620320OtherRR MEDICARE
MA000000028361OtherHEALTH NET
MA240783OtherHARVARD PILGRIM
MAJ30738OtherBCBS MA
MA3127940Medicaid
MA404087OtherBLUE CHIP RI HMO
MA16-00012OtherUNITED HEALTHCARE
MA4700OtherBCBS RI
MA5450948003OtherCIGNA MA
MA240783OtherHARVARD PILGRIM
MA404087OtherBLUE CHIP RI HMO
MAJ30738OtherBLUE CARE ELECT
F85411Medicare UPIN