Provider Demographics
NPI:1578372876
Name:CARON, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:CARON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 LISBON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3545
Mailing Address - Country:US
Mailing Address - Phone:207-333-7558
Mailing Address - Fax:
Practice Address - Street 1:1567 LISBON ST STE 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3545
Practice Address - Country:US
Practice Address - Phone:207-333-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1945249172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver