Individual
TIANA MARI LARSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2800 MAIN ST, BRIDGEPORT, CT 06606-4292
(203) 576-6000
Mailing address
1290 SILAS DEANE HWY, HHC-CVO, WETHERSFIELD, CT 06109-4337
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
56217
CT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
56217
CT
Other
Enumeration date
03/28/2013
Last updated
05/02/2025
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