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NPI Code Detail

MEDICARE: DR. MARISA COLLEEN CLANCY LARIMER D.O.

MEDICARE: DR. MARISA COLLEEN CLANCY LARIMER D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician2006-01120NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023025699
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARISA COLLEEN CLANCY LARIMER D.O.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-384-7840
Fax Number :
Provider Business Practice Location Address
First Line : 8110 HEALTHCARE LOOP
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-7069
Country : US
Telephone Number : 704-316-2312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 10/25/2020

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