Provider Demographics
NPI:1316943079
Name:LAREAU, EUGENE R (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:R
Last Name:LAREAU
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-437-7989
Mailing Address - Fax:540-437-7984
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5800
Practice Address - Fax:540-689-5801
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021229208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0124751000Medicaid
VAC05754OtherMEDICARE GROUP PTAN
VA007341755Medicaid
VA082280OtherSOUTHERN HEALTH
VA016759R54Medicare PIN