Provider Demographics
NPI:1184730384
Name:SHRAGER, LARRY M (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:SHRAGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 SPROUL RD SUITE 100
Mailing Address - Street 2:MARPLE COMMONS
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1539
Mailing Address - Country:US
Mailing Address - Phone:610-353-3500
Mailing Address - Fax:610-353-2015
Practice Address - Street 1:2000 SPROUL RD SUITE 100
Practice Address - Street 2:MARPLE COMMONS
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1539
Practice Address - Country:US
Practice Address - Phone:610-353-3500
Practice Address - Fax:610-353-2015
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 005571L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP663877OtherOXFORD
PA0080673000OtherIBC PRODUCTS
PA010033426OtherMEDICARE RR
PA0011230050005Medicaid
PA0080673000OtherKEYSTONE
PA0112300503OtherAMERICHOICE
PA112682OtherCOVENTRY
PA115054OtherPA BLUE SHIELD
PA2538151OtherAETNA
PA112682OtherCOVENTRY
PA115054OtherPA BLUE SHIELD