Provider Demographics
NPI:1144216268
Name:LARSON, JEANNE N (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:N
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JEANNE
Other - Middle Name:N
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 WALNUT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1168
Mailing Address - Country:US
Mailing Address - Phone:717-761-0208
Mailing Address - Fax:717-761-2023
Practice Address - Street 1:1 KACEY CT
Practice Address - Street 2:SUITE 101
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-9223
Practice Address - Country:US
Practice Address - Phone:717-591-0961
Practice Address - Fax:717-591-0980
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101475940Medicaid
PA101475940Medicaid
A47637Medicare UPIN