Healthcare Provider Details

I. General information

NPI: 1326010786
Provider Name (Legal Business Name): LARRY M ESPENSHADE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 2ND ST
HIGHSPIRE PA
17034-1002
US

IV. Provider business mailing address

3 WALNUT ST SUITE 206
LEMOYNE PA
17043-1168
US

V. Phone/Fax

Practice location:
  • Phone: 717-939-4975
  • Fax: 717-939-3596
Mailing address:
  • Phone: 717-761-0208
  • Fax: 717-761-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003483L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: