Provider Demographics
NPI:1215019138
Name:HARIKIAN, LARRY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALLEN
Last Name:HARIKIAN
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 1:1867 AIRPORT WAY
Mailing Address - Street 2:STE 130B
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4056
Mailing Address - Country:US
Mailing Address - Phone:907-452-2178
Mailing Address - Fax:907-452-3524
Practice Address - Street 1:1867 AIRPORT WAY
Practice Address - Street 2:STE 130B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4056
Practice Address - Country:US
Practice Address - Phone:907-452-2178
Practice Address - Fax:907-452-3524
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2223208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD22232Medicaid
AKG14266Medicare UPIN
AKMD22232Medicaid