Healthcare Provider Details

I. General information

NPI: 1881887776
Provider Name (Legal Business Name): LARISSA R NEGRON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW MAYNARD RD STE 110
CARY NC
27513-8707
US

IV. Provider business mailing address

1100 NW MAYNARD RD STE 110
CARY NC
27513-8707
US

V. Phone/Fax

Practice location:
  • Phone: 984-230-8662
  • Fax: 919-249-5165
Mailing address:
  • Phone: 984-230-8662
  • Fax: 919-249-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35090237
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-6794
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: