Provider Demographics
NPI:1154691343
Name:PROGRESSIVE MEDICINE, LLC
Entity type:Organization
Organization Name:PROGRESSIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-269-7011
Mailing Address - Street 1:174 WEST ST
Mailing Address - Street 2:SUITE 200, BOX 1
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3434
Mailing Address - Country:US
Mailing Address - Phone:860-269-7011
Mailing Address - Fax:860-269-7004
Practice Address - Street 1:174 WEST ST
Practice Address - Street 2:SUITE 200, BOX 1
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3434
Practice Address - Country:US
Practice Address - Phone:860-269-7011
Practice Address - Fax:860-269-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032629208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F60884Medicare UPIN