Provider Demographics
NPI: | 1699767996 |
---|---|
Name: | LARKIN, ERNEST W III (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | ERNEST |
Middle Name: | W |
Last Name: | LARKIN |
Suffix: | III |
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 751069 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28275-1069 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-744-3253 |
Mailing Address - Fax: | 252-744-3194 |
Practice Address - Street 1: | 600 MOYE BLVD |
Practice Address - Street 2: | |
Practice Address - City: | GREENVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27834-4300 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-744-2207 |
Practice Address - Fax: | 252-744-3616 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-22 |
Last Update Date: | 2008-05-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 20305 | 207ZP0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 51041 | Other | BCBS NC |
NC | 8951041 | Medicaid | |
NC | 220020374 | Other | RAILROAD MEDICARE |
NC | 220020374 | Other | RAILROAD MEDICARE |
NC | 2163417 | Medicare ID - Type Unspecified |