Healthcare Provider Details

I. General information

NPI: 1164483004
Provider Name (Legal Business Name): WILLIAM G LARSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 MOORES CHAPEL RD
CHARLOTTE NC
28214-9453
US

IV. Provider business mailing address

7920 MOORES CHAPEL RD
CHARLOTTE NC
28214-9453
US

V. Phone/Fax

Practice location:
  • Phone: 704-926-7800
  • Fax: 704-926-7806
Mailing address:
  • Phone: 704-926-7800
  • Fax: 704-926-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9300510
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: