Provider Demographics
NPI:1841260239
Name:LARIMER, MARK ROBERT (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ROBERT
Last Name:LARIMER
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 1:4310 SNIPE CREEK LN
Mailing Address - Street 2:APT. A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3442
Mailing Address - Country:US
Mailing Address - Phone:919-602-8705
Mailing Address - Fax:
Practice Address - Street 1:4310 SNIPE CREEK LN
Practice Address - Street 2:APT. A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3442
Practice Address - Country:US
Practice Address - Phone:919-602-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951036Medicaid
NC2227858EMedicare ID - Type Unspecified
NC8951036Medicaid