Provider Demographics
NPI:1932163722
Name:HARDWAY, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:HARDWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10003 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN ON GAULEY
Mailing Address - State:WV
Mailing Address - Zip Code:26208-7713
Mailing Address - Country:US
Mailing Address - Phone:304-226-5527
Mailing Address - Fax:304-226-5531
Practice Address - Street 1:10003 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:CAMDEN ON GAULEY
Practice Address - State:WV
Practice Address - Zip Code:26208-7713
Practice Address - Country:US
Practice Address - Phone:304-226-5725
Practice Address - Fax:304-226-5531
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV20074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2003133000Medicaid
WV2003133000Medicaid
WV4172431Medicare PIN