Provider Demographics
NPI:1780887893
Name:FIELDS, LARRY E (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:FIELDS
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 1:5 DICKISON RD
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-2912
Mailing Address - Country:US
Mailing Address - Phone:540-226-8371
Mailing Address - Fax:845-726-9964
Practice Address - Street 1:5 DICKISON RD
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-2912
Practice Address - Country:US
Practice Address - Phone:540-226-8371
Practice Address - Fax:845-726-9964
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9B05207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR9B05OtherSTATE LICENSE
AF1366574OtherDEA