Provider Demographics
NPI:1457687121
Name:ARNOLD, LARRY RAYMOND (PA-C)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:RAYMOND
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 PLAINS TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7012
Mailing Address - Country:US
Mailing Address - Phone:570-825-8741
Mailing Address - Fax:570-825-8990
Practice Address - Street 1:ROUTE 29
Practice Address - Street 2:
Practice Address - City:NOXEN
Practice Address - State:PA
Practice Address - Zip Code:18636-9766
Practice Address - Country:US
Practice Address - Phone:570-298-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant