Provider Demographics
NPI:1205890084
Name:LARKIN, GREGORY LUKE (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LUKE
Last Name:LARKIN
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 1:464 CONGRESS AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1361
Mailing Address - Country:US
Mailing Address - Phone:203-785-2353
Mailing Address - Fax:203-785-4580
Practice Address - Street 1:464 CONGRESS AVE STE 260
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1361
Practice Address - Country:US
Practice Address - Phone:203-785-2353
Practice Address - Fax:203-785-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050271L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151006701Medicaid
TX8887M3Medicare ID - Type Unspecified
TX151006701Medicaid