Provider Demographics
NPI:1225095318
Name:LAROSE, KATHLEEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:LAROSE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:FINECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:5928 N HILLS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4236
Mailing Address - Country:US
Mailing Address - Phone:919-876-9991
Mailing Address - Fax:
Practice Address - Street 1:5928 N HILLS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4236
Practice Address - Country:US
Practice Address - Phone:919-876-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC362213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890800XMedicaid
NCU51494Medicare UPIN
NC890800XMedicaid