Provider Demographics
NPI:1710979026
Name:LARSEN, LARS C (MD)
Entity Type:Individual
Prefix:DR
First Name:LARS
Middle Name:C
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS FAMILY MEDICINE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 HEART DRIVE
Practice Address - Street 2:ECU PHYSICIANS FAMILY MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8944
Practice Address - Country:US
Practice Address - Phone:252-744-4611
Practice Address - Fax:252-744-2056
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-10-26
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Provider Licenses
StateLicense IDTaxonomies
NC27479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC80106314OtherRAILROAD MEDICARE
NC51050OtherBCBS NC
NC7951050Medicaid
NC80106314OtherRAILROAD MEDICARE
NC7951050Medicaid