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 34 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