Provider Demographics
NPI:1033105929
Name:LARRISON, WAYNE IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:IAN
Last Name:LARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:46 PRINCE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1600
Mailing Address - Country:US
Mailing Address - Phone:203-787-6161
Mailing Address - Fax:203-776-0300
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:SUITE 402A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1600
Practice Address - Country:US
Practice Address - Phone:203-787-6161
Practice Address - Fax:203-776-0300
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2023-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT030754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001307546Medicaid