Provider Demographics
NPI:1326115171
Name:LARSON, MICHELE C (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:C
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DUKE HEALTH CARY PL STE 210
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6760
Mailing Address - Country:US
Mailing Address - Phone:919-385-4650
Mailing Address - Fax:
Practice Address - Street 1:100 DUKE HEALTH CARY PL STE 210
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6760
Practice Address - Country:US
Practice Address - Phone:919-385-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A1542OtherMEDCOST
NC7951059Medicaid
51059OtherBCBS
51059OtherBCBS
NC7951059Medicaid