Healthcare Provider Details

I. General information

NPI: 1063466324
Provider Name (Legal Business Name): DURGA S. LARKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 VILLAGE SQUARE DRIVE BUILDING 24
SOUTH KINGSTOWN RI
02879
US

IV. Provider business mailing address

150 EAST MANNING ST.
PROVIDENCE RI
02906
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-2020
  • Fax: 401-789-4113
Mailing address:
  • Phone: 401-272-2020
  • Fax: 401-421-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD07869
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: