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General NPI Number Information
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NPI Number | 1780799437
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Entity Type | Individual
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Provider Name | HEIDI M LARSON MD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 2 GREAT FALLS PLZ STE 21
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City | AUBURN
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State | ME
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Zip | 04210-5966
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Country | US
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Telephone | 207-330-3950
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Fax | 207-330-3955
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Provider Business Mailing Address
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Address Line | 161 CORPORATE DR
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City | PORTSMOUTH
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State | NH
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Zip | 03801-6825
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Country | US
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Telephone | 603-431-5154
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD14388
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License Number State | ME
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