Provider Demographics
NPI:1003280793
Name:LITTLE, MEGHAN C (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:C
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:C
Other - Last Name:KNAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:601 ELMWOOD AVE BOX SURG
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-564-8007
Mailing Address - Fax:
Practice Address - Street 1:125 RED CREEK DR STE 211
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4262
Practice Address - Country:US
Practice Address - Phone:585-486-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193702086X0206X
NY019370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology