Provider Demographics
NPI:1326001447
Name:DASHOW, LARRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:DASHOW
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:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-0219
Mailing Address - Country:US
Mailing Address - Phone:910-259-8001
Mailing Address - Fax:910-259-8003
Practice Address - Street 1:308 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5048
Practice Address - Country:US
Practice Address - Phone:910-259-8001
Practice Address - Fax:910-259-8003
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913350Medicaid
NC13350OtherBCBS OF NC PROVIDER #
NC13350OtherBCBS OF NC PROVIDER #
NCE88240Medicare UPIN