Provider Demographics
NPI:1124011457
Name:WASSER, LARRY STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:STEPHEN
Last Name:WASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:STE 1A
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-2881
Mailing Address - Fax:203-740-2111
Practice Address - Street 1:31 OLD ROUTE 7
Practice Address - Street 2:STE 1A
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1714
Practice Address - Country:US
Practice Address - Phone:203-740-2881
Practice Address - Fax:203-740-2111
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029504207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001295048Medicaid
CTA60789Medicare UPIN
CT001295048Medicaid