Healthcare Provider Details

I. General information

NPI: 1518501923
Provider Name (Legal Business Name): MATTHEW LARRABEE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 N CALVERT ST
BALTIMORE MD
21218-4405
US

IV. Provider business mailing address

2743 N CALVERT ST
BALTIMORE MD
21218-4405
US

V. Phone/Fax

Practice location:
  • Phone: 443-506-4380
  • Fax:
Mailing address:
  • Phone: 443-506-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR214139
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: