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General NPI Number Information
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NPI Number | 1861485245
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Entity Type | Individual
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Provider Name | SIGRID A LARSON MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 9625 FRANKFORD AVE NE PHYSICIAN SERVICES
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City | PHILADELPHIA
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State | PA
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Zip | 19114-2846
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Country | US
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Telephone | 215-637-9400
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Fax | 215-637-7970
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Provider Business Mailing Address
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Address Line | 3542 WELSH RD NE PHYSICIAN SERVICES
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City | PHILADELPHIA
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State | PA
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Zip | 19136-2623
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Country | US
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Telephone | 215-333-6888
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Fax | 215-333-3945
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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 | MD420932
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License Number State | PA
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