MEDICARE: LARRY ALLEN NANCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101037658	VA
2	207V00000X	Obstetrics & Gynecology Physician	0101037658	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104828045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY ALLEN NANCE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	866-775-3551
Fax Number	:	703-365-7702

Provider Business Practice Location Address
First Line	:	7915 LAKE MANASSAS DRIVE
Second Line	:	SUTIE 205
City	:	GAINESVILLE
State	:	NC
Zip	:	20155-3260
Country	:	US
Telephone Number	:	866-755-3551
Fax Number	:	703-365-7702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/11/2014

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