Individual provider Active NPI

Roshaun Hardy, DC

  • Chiropractor
  • Laurel, MD
National Provider Identifier
1336524966
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104557266 Issued in VA
Practice address
9811 Mallard Dr Ste 218
Laurel, MD 20708-3199
Phone
(914) 879-4572
NPI assigned
Jul 24, 2015
Last updated
Mar 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104557266 VA Primary

Addresses

Primary practice location

9811 Mallard Dr Ste 218
Laurel, MD 20708-3199

Mailing address

9811 Mallard Dr Ste 218
Laurel, MD 20708-3199
Phone (914) 879-4572

Other practice location 1

13662 Office Pl Ste 103
Woodbridge, VA 22192-4217
Phone (914) 879-4572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0104557266VAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Kamper Chiropractic & Rehabilitation Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1336524966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9811 MALLARD DR STE 218",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083199",
            "telephone_number": "914-879-4572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9811 MALLARD DR STE 218",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083199",
            "telephone_number": "914-879-4572"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13662 Office Pl Ste 103",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221924217",
            "country_code": "US",
            "telephone_number": "914-879-4572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARDY",
        "first_name": "ROSHAUN",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-24",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104557266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.