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1588764385

NPI Code Detail

MEDICARE: LARRY VAN CARSON MD

MEDICARE: LARRY VAN CARSON MD

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
1	207T00000X	Neurological Surgery Physician	0101039834	VA
2	207T00000X	Neurological Surgery Physician	20197	GA
3	207T00000X	Neurological Surgery Physician	2008-02090	NC
4	207T00000X	Neurological Surgery Physician	14284	WV
5	207T00000X	Neurological Surgery Physician	25835	TN
6	208200000X	Plastic Surgery Physician	01082907A	IN
7	207T00000X	Neurological Surgery Physician	01082907A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1588764385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY VAN CARSON MD

Provider Business Mailing Address
First Line	:	PO BOX 9788
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-9788
Country	:	US
Telephone Number	:	910-295-0215
Fax Number	:	910-295-0218

Provider Business Practice Location Address
First Line	:	11104 PARKVIEW CIRCLE DR STE 110
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1673
Country	:	US
Telephone Number	:	260-425-6780
Fax Number	:	260-425-6615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/09/2024

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Directions to “ LARRY VAN CARSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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