Healthcare Provider Details

I. General information

NPI: 1730281734
Provider Name (Legal Business Name): ROBIN J LARSON M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE PALLIATIVE MEDICINE
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5402
  • Fax:
Mailing address:
  • Phone: 603-650-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042-0010289
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number11418
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: