Provider Demographics
NPI:1154371474
Name:HARDEN, AMY JO (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:HARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:SILLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1204 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4312
Mailing Address - Country:US
Mailing Address - Phone:276-783-2511
Mailing Address - Fax:276-783-2532
Practice Address - Street 1:1204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4312
Practice Address - Country:US
Practice Address - Phone:276-783-2511
Practice Address - Fax:276-783-2532
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146918OtherANTHEM BC PROVIDER NUMBER
VA010088577Medicaid
VA321590OtherSOUTHERN HEALTH PROVIDER
VATN0102OtherJOHN DEERE PROVIDER NO.
VATN0102OtherJOHN DEERE PROVIDER NO.