Individual
MR. LARRY A WASKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1838 GREENE TREE RD, SUITE 460, BALTIMORE, MD 21208-6391
(410) 581-1600
Mailing address
25 CROSSROADS DR, SUITE 306, OWINGS MILLS, MD 21117-5421
(410) 581-1600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0000274
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970005850
R/R MEDICARE PROVIDER #
MD
Enumeration date
04/04/2006
Last updated
05/06/2014
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