Provider Demographics
NPI:1316938970
Name:LARNED, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LARNED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3185
Mailing Address - Fax:215-707-1684
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3185
Practice Address - Fax:215-707-1684
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002601207W00000X
PAMD030312E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4304455OtherAETNA
DE510353416OtherBLUE SHIELD
DE342958OtherMAMSI
DE510353416OtherMID ATLANTIC
DE0080202000OtherAMERIHEALTH HMO
DE510353416001OtherTRICARE
DE27364OtherCOVENTRY
DE0000158301Medicaid
DELA180017152OtherRR MEDICARE
DE0080202000OtherAMERIHEALTH HMO
DE27364OtherCOVENTRY
DE4304455OtherAETNA