Provider Demographics
NPI:1154381465
Name:DAVIDSON, LARRY STEVE (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:STEVE
Last Name:DAVIDSON
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 1:109 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3333
Mailing Address - Country:US
Mailing Address - Phone:864-224-5700
Mailing Address - Fax:864-226-0680
Practice Address - Street 1:109 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3333
Practice Address - Country:US
Practice Address - Phone:864-224-5700
Practice Address - Fax:864-226-0680
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400460207T00000X
SCMD16408207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00404250OtherRAILROAD MEDICARE
SCP01616429OtherRR MEDICARE
NC891273NMedicaid
SCN00460Medicaid
SCP01616429OtherRR MEDICARE
NCF85113Medicare UPIN
SCAA72007111Medicare PIN
NC2282446AMedicare PIN