Provider Demographics
NPI:1700847506
Name:LARSON, BARBARA JEANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEANNE
Last Name:LARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-8710
Mailing Address - Country:US
Mailing Address - Phone:508-747-1318
Mailing Address - Fax:508-747-1410
Practice Address - Street 1:116 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8710
Practice Address - Country:US
Practice Address - Phone:508-747-1318
Practice Address - Fax:508-747-1410
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002657L363A00000X, 363AM0700X
MAPA4622363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA138350OtherHEALTHAMERICA
PA2517979OtherUNITEDHEALTHCARE
PA242966YHMKOtherMEDICARE PTAN
S72546Medicare UPIN