Provider Demographics
NPI:1023542826
Name:LARSON, VALERIE ANN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ANN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 DE BARY PL
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2821
Mailing Address - Country:US
Mailing Address - Phone:973-525-6618
Mailing Address - Fax:
Practice Address - Street 1:560 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5113
Practice Address - Country:US
Practice Address - Phone:914-345-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328333207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology