Provider Demographics
NPI:1205803285
Name:LARZO, CRISTOFORO (MD)
Entity type:Individual
Prefix:DR
First Name:CRISTOFORO
Middle Name:
Last Name:LARZO
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 1:9050 EXECUTIVE PARK DR STE 202A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4670
Mailing Address - Country:US
Mailing Address - Phone:423-756-1512
Mailing Address - Fax:865-934-3884
Practice Address - Street 1:2412 N JOHN B DENNIS HWY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4772
Practice Address - Country:US
Practice Address - Phone:423-578-4364
Practice Address - Fax:423-578-4372
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47455207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002341Medicaid
NCNC0241AOtherMEDICARE
TN103I187084OtherMEDICARE
VAVV2099AOtherMEDICARE
WV3810002341Medicaid
I32649Medicare UPIN