Provider Demographics
NPI:1740230317
Name:LARKINS, MARK VAUGHN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:VAUGHN
Last Name:LARKINS
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 1:2580 HAYMAKER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3500
Mailing Address - Country:US
Mailing Address - Phone:412-858-7766
Mailing Address - Fax:412-858-7769
Practice Address - Street 1:2580 HAYMAKER RD STE 106
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3500
Practice Address - Country:US
Practice Address - Phone:412-858-7766
Practice Address - Fax:412-858-7769
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085101A207T00000X
MEMD26048207T00000X
SC52235207T00000X
PAMD045460E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103704013Medicaid
IN068010678OtherMEDICARE PTAN
11097714OtherCAQH
INQ00107149OtherRAILROAD PTAN
IN300046661Medicaid