Provider Demographics
NPI:1598840886
Name:LARSON, HAROLD ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD ELLIOTT
Middle Name:
Last Name:LARSON
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:C/O I AM, PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:KABUL
Mailing Address - State:AF
Mailing Address - Zip Code:W138AL
Mailing Address - Country:AF
Mailing Address - Phone:937-998-1998
Mailing Address - Fax:
Practice Address - Street 1:WAZIR AKBAR KNAN HOSPITAL
Practice Address - Street 2:
Practice Address - City:KABUL
Practice Address - State:AF
Practice Address - Zip Code:01752-1207
Practice Address - Country:AF
Practice Address - Phone:937-998-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine