Individual
MICHAEL F. LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
485 ARSENAL ST, WATERTOWN, MA 02472-5091
(617) 972-5540
(617) 972-5564
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
160807
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0037398
NEIGHBORHOOD HEALTH PLAN
MA
01
—
347529
TUFTS HEALTH PLAN
MA
01
—
J21527
BLUE CROSS
MA
Enumeration date
06/07/2006
Last updated
07/14/2011
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