Provider Demographics
NPI:1841386968
Name:LARSON, ERIC K (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:K
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 PLEASANT ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2553
Mailing Address - Country:US
Mailing Address - Phone:603-228-5420
Mailing Address - Fax:603-228-7228
Practice Address - Street 1:280 PLEASANT STREET
Practice Address - Street 2:SUITE 12
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2553
Practice Address - Country:US
Practice Address - Phone:603-228-5420
Practice Address - Fax:603-228-7228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH74142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001617Medicaid
NH020403439OtherTRICARE
NH020403439OtherCIGNA
NH020403439OtherHARVARD PILGRIM
NH0102702Y0NH01OtherANTHEM
NH020403439OtherCIGNA
D03496Medicare UPIN