Provider Demographics
NPI:1699761676
Name:LARSON, STEVEN DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3310
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:12330 PINECREST RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1642
Practice Address - Country:US
Practice Address - Phone:703-476-1050
Practice Address - Fax:703-476-7126
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00532Medicare UPIN
VAC89089Medicare UPIN
VA080153827Medicare ID - Type UnspecifiedRAILROAD