Provider Demographics
NPI:1144240789
Name:LARSEN, LANCE A (MD,FACC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:A
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HERRICK ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5900
Mailing Address - Country:US
Mailing Address - Phone:978-927-8400
Mailing Address - Fax:978-922-1452
Practice Address - Street 1:75 HERRICK ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5900
Practice Address - Country:US
Practice Address - Phone:978-927-8400
Practice Address - Fax:978-922-1452
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59741174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA060058690OtherRAILROAD MEDICARE
MA4231092OtherAETNA
MA2500717OtherUNITED HEALTHCARE
MAJ07711OtherBLUE CROSS BLUE SHIELD
MA3053024Medicaid
MA042804155OtherCIGNA
MA60917OtherHARVARD PILGRIM
MA97126301OtherNETWORK HEALTH PLAN
MA0016080OtherNEIGHBORHOOD HEALTH PLAN
MA059741OtherTUFTS HEALTH PLAN
MA32041OtherFALLON COMMUNITY HEALTH
MA2500717OtherUNITED HEALTHCARE
MA4231092OtherAETNA