Individual ProviderSigrid A LarsonFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address9625 Frankford Ave, Ne Physician Services, Philadelphia, PA 19114-2846(215) 637-9400(215) 333-6888PECOS EnrollmentBased on the most recent information from CMS, provider Sigrid A Larson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1861485245Provider TypeIndividualFull NameLarson, Sigrid ATitleMs.CredentialMDGenderFemaleSole ProprietorNoEnumeration Date8/31/2005Last Updated9/6/2007Contact InformationPractice LocationPractice Address9625 Frankford Ave, Ne Physician Services, Philadelphia, PA 19114-2846Phone(215) 637-9400Fax(215) 637-7970Mailing LocationMailing Address3542 Welsh Rd, Ne Physician Services, Philadelphia, PA 19136-2623Phone(215) 333-6888Fax(215) 333-3945Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMD420932PennsylvaniaProvider IdentifiersIDDescriptionIssuerID0019564760001DescriptionMedicaidIssuerUnlistedPennsylvaniaID1472127DescriptionOtherIssuerIBCPennsylvaniaIDLA1472127DescriptionOtherIssuerBLUE SHIELDPennsylvaniaIDP00048396DescriptionOtherIssuerRR MEDICAREIDP2928460DescriptionOtherIssuerOXFORDID30008940DescriptionOtherIssuerKEYSTONE MERCYPennsylvaniaID2155650000DescriptionOtherIssuerKEYSTONEPennsylvaniaID7273442DescriptionOtherIssuerAETNAPennsylvania