Provider Demographics
NPI:1336343896
Name:LARSEN, RONALD AXEL (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:AXEL
Last Name:LARSEN
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 1:18767 THOMAS LEE WAY
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8225
Mailing Address - Country:US
Mailing Address - Phone:571-333-2270
Mailing Address - Fax:
Practice Address - Street 1:18767 THOMAS LEE WAY
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8225
Practice Address - Country:US
Practice Address - Phone:571-333-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT162106-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine