Provider Demographics
NPI:1952583619
Name:LARSEN, CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 OMAR DR
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1233
Mailing Address - Country:US
Mailing Address - Phone:443-790-3366
Mailing Address - Fax:
Practice Address - Street 1:575 MAIN ST
Practice Address - Street 2:SUITE # 351
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4343
Practice Address - Country:US
Practice Address - Phone:301-498-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant