Healthcare Provider Details

I. General information

NPI: 1417273632
Provider Name (Legal Business Name): COURTNEY LARKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY GAY M.D.

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 GLENWAY AVE STE 300
CINCINNATI OH
45211-6378
US

IV. Provider business mailing address

6350 GLENWAY AVE STE 300
CINCINNATI OH
45211-6378
US

V. Phone/Fax

Practice location:
  • Phone: 513-481-9700
  • Fax: 513-389-7091
Mailing address:
  • Phone: 513-481-9700
  • Fax: 513-389-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.127661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: