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General NPI Number Information
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NPI Number | 1003894940
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Entity Type | Individual
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Provider Name | KENNETH ROBERT LARSEN D.O
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Gender | Male
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Dates
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Enumeration Date | 12/31/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 455 TOLL GATE RD
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City | WARWICK
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State | RI
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Zip | 02886-2759
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Country | US
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Telephone | 401-736-4289
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Fax |
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Provider Business Mailing Address
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Address Line | 382 GRINDSTONE HILL RD
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City | NORTH STONINGTON
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State | CT
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Zip | 06359-1106
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Country | US
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Telephone | 860-599-1871
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Fax | 860-599-6071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 490
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 273
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License Number State | CT
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