Larry Allen Nance, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Gainesville, NC
NPI 1104828045 · NPPES record last updated Feb 11, 2014
Key facts
- NPI
- 1104828045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 0101037658 (NC)
- Practice address
- 7915 Lake Manassas Drive
Sutie 205
Gainesville, NC 20155-3260 - Phone
- (866) 755-3551
- Fax
- (703) 365-7702
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101037658 | VA | MD | Specialist |
| 0101037658 | NC | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edmund Stephen Petrilli, M.D., P.C. | Past | Accepting new patients | |
| Eugene J Louieng, MD, PC | Obstetrics & Gynecology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 0101037658 | VA | |
| Obstetrics & Gynecology Physician | 207V00000X | 0101037658 | NC | Yes |
Addresses
Primary practice location
7915 Lake Manassas Drive
Sutie 205
Gainesville, NC 20155-3260
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (866) 775-3551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006213987 | Medicaid | VA |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.