Provider Demographics
NPI:1790319150
Name:LAROWE, CATHERINE EDELMIRA (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:EDELMIRA
Last Name:LAROWE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 7095
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-5185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39TH MEDICAL GROUP
Practice Address - Street 2:UNIT 7095
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824-5185
Practice Address - Country:US
Practice Address - Phone:314-676-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL1647207Q00000X
390200000X
VA0102206809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program