Provider Demographics
NPI:1912084815
Name:HARDACRE, MADELINE RENEE (MD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:RENEE
Last Name:HARDACRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-3900
Practice Address - Street 1:1500 E 2ND ST STE 206
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1198
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV17160207V00000X, 207VB0002X
AL29158207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV17160OtherNV LICENSE
NV10752358OtherCAQH
IN233020DMedicare PIN