Provider Demographics
NPI:1548334592
Name:LARSEN, ELIZABETH S (PA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:23 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1856
Mailing Address - Country:US
Mailing Address - Phone:603-448-5302
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DARTMOUTH HITCHCOCK MEDICAL CENTER
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-448-1941
Practice Address - Fax:603-448-6059
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30332163Medicaid
NHP62929Medicare UPIN
NHAP1737Medicare ID - Type Unspecified