Provider Demographics
NPI:1225080302
Name:LARSON, CHRISTINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:L
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:701 GROVE RD
Mailing Address - Street 2:GHS DEPARTMENT OF NEONATOLOGY
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5611
Mailing Address - Country:US
Mailing Address - Phone:864-455-7939
Mailing Address - Fax:864-455-3685
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:GHS DEPARTMENT OF NEONATOLOGY
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7939
Practice Address - Fax:864-455-3685
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC229032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901616Medicaid
SC229032Medicaid
NC5901616Medicaid