1063423010 NPI number — MR. DAVID M LARRABEE MD

Table of content: MR. DAVID M LARRABEE MD (NPI 1063423010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063423010 NPI number — MR. DAVID M LARRABEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARRABEE
Provider First Name:
DAVID
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063423010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 SHORE DR
Provider Second Line Business Mailing Address:
STE 303
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-3154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-856-0458
Provider Business Mailing Address Fax Number:
508-852-5089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 SHORE DR
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-856-0458
Provider Business Practice Location Address Fax Number:
508-852-5089
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  212172 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102740 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2658283 . This is a "AETNA BLUE BELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00045043 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042103577 . This is a "HMH TAX ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 711538 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 977754 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4489401004 . This is a "CIGNA AVON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212172 . This is a "TUFTS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1211013 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: A32985 . This is a "MEDICARE PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220019 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4217582 . This is a "CIGNA SCRANTON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52877 . This is a "FALLON HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J24197 . This is a "BCBS QUINCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212172 . This is a "LIC#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24128 . This is a "FALLON HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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