Provider Demographics
NPI:1093747727
Name:LARSON, ELIZABETH FRANCES (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:FRANCES
Last Name:LARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81 OLD COLONY WAY STE D
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-3278
Mailing Address - Country:US
Mailing Address - Phone:508-240-1141
Mailing Address - Fax:508-240-3031
Practice Address - Street 1:81 OLD COLONY WAY STE D
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3278
Practice Address - Country:US
Practice Address - Phone:508-240-1141
Practice Address - Fax:508-240-3031
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1114363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS94161Medicare UPIN