Provider Demographics
NPI:1033481486
Name:EDWIN R. LARSON, MD, INC.
Entity Type:Organization
Organization Name:EDWIN R. LARSON, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-793-6550
Mailing Address - Street 1:9200 MONTGOMERY RD STE 8A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7730
Mailing Address - Country:US
Mailing Address - Phone:513-793-6550
Mailing Address - Fax:513-793-2191
Practice Address - Street 1:9200 MONTGOMERY RD STE 8A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7730
Practice Address - Country:US
Practice Address - Phone:513-793-6550
Practice Address - Fax:513-793-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty