Provider Demographics
NPI:1851341614
Name:LARSEN, CHRISTIAN PETER (MD PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:PETER
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOODRUFF CIR
Mailing Address - Street 2:STE 5105 WMB
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-727-8466
Mailing Address - Fax:404-727-3660
Practice Address - Street 1:101 WOODRUFF CIR
Practice Address - Street 2:STE 5105 WMB
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-727-8466
Practice Address - Fax:404-727-3660
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033853204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
02BDB52Medicare ID - Type Unspecified
E88103Medicare UPIN