Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 253843 | MA |
NPI | 1124091905 |
---|---|
Provider Name | Dr. Susan Elizabeth Hardy |
First Address | Worcester, MA 01604-2737 |
Second Address | Worcester, MA 01604-2737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 04/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I08112 | (02) | PA |