Provider Demographics
NPI:1033104062
Name:SUECOF, LARRY ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALAN
Last Name:SUECOF
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EXETER PARK
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1555
Mailing Address - Country:US
Mailing Address - Phone:407-417-7478
Mailing Address - Fax:
Practice Address - Street 1:5 EXETER PARK
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1555
Practice Address - Country:US
Practice Address - Phone:407-417-7478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000281213ES0103X, 213ES0103X, 213E00000X, 213EP1101X
FLPOOOO2293213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0600211278OtherCONNECTICARE
CT0724234 001OtherCIGNA
480000668OtherMEDICARE
CT06-1406459OtherCOLONIAL COOPERATIVE CARE
CT1033104062OtherANTHEM BCBS
CT2534362OtherAETNA
CTP4041219OtherOXFORD
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherUNITED HEALTHCARE
CT06-1406459OtherFOCUS
CT0R3020OtherHEALTH NET
480000668OtherMEDICARE
CT0R3020OtherHEALTH NET
CT1033104062OtherANTHEM BCBS
MA0358436Medicaid
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT0724234 001OtherCIGNA
CTP4041219OtherOXFORD
CT06-1406459OtherGREAT WEST HEALTHCARE
CT1033104062OtherANTHEM BCBS