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General NPI Number Information
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NPI Number | 1285637207
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Entity Type | Individual
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Provider Name | TRACY M LARSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 6401 MORRISON BLVD # 2A
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City | CHARLOTTE
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State | NC
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Zip | 28211-3800
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Country | US
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Telephone | 704-390-7150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12734
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City | CHARLOTTE
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State | NC
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Zip | 28220-2734
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Country | US
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Telephone | 704-390-7150
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 9900925
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License Number State | NC
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