Provider Demographics
NPI:1326010786
Name:ESPENSHADE, LARRY M (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:M
Last Name:ESPENSHADE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WALNUT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1168
Mailing Address - Country:US
Mailing Address - Phone:717-761-0208
Mailing Address - Fax:717-761-2023
Practice Address - Street 1:40 2ND ST
Practice Address - Street 2:
Practice Address - City:HIGHSPIRE
Practice Address - State:PA
Practice Address - Zip Code:17034-1002
Practice Address - Country:US
Practice Address - Phone:717-939-4975
Practice Address - Fax:717-939-3596
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003483L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98626Medicare UPIN
078472Medicare ID - Type Unspecified