Provider Demographics
NPI:1154364677
Name:HARDWICK, MATTHEW G (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:HARDWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MERCHANT ST, STE 220 - ATTN CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-645-9827
Practice Address - Street 1:1425 N FAIRFIELD RD.
Practice Address - Street 2:STE 120
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-4543
Practice Address - Country:US
Practice Address - Phone:937-320-3888
Practice Address - Fax:937-320-3848
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054710H208000000X
OH35054710208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0740881Medicaid
OHF56005Medicare UPIN
OH0740881Medicaid