Provider Demographics
NPI:1043252653
Name:LARRABEE, ROLAND (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:LARRABEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:317 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1344
Practice Address - Country:US
Practice Address - Phone:717-786-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025172E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP002623OtherGATEWAY
PA001390706Medicaid
PA0389560000OtherINDEPENDENCE BLUE CROSS
PA080114619OtherRR MEDICARE
PA50055842OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA7289716OtherCIGNA
PA000568289OtherHIGHMARK
PA5636313OtherAETNA-NON HMO
PA30013212OtherKEYSTONE MERCY
PA40261OtherGEISINGER
PA0530956OtherAETNA-HMO
PA000000127170OtherUNISON
PA1001450OtherMERCY
PA000568289OtherHIGHMARK
PAP002623OtherGATEWAY