Provider Demographics
NPI:1003696246
Name:LITTLE, MADDISON E (RD)
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:E
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MADDI
Other - Middle Name:
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8602 CHESAPEAKE LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20714-3070
Mailing Address - Country:US
Mailing Address - Phone:484-636-7797
Mailing Address - Fax:
Practice Address - Street 1:8602 CHESAPEAKE LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:NORTH BEACH
Practice Address - State:MD
Practice Address - Zip Code:20714-3070
Practice Address - Country:US
Practice Address - Phone:484-636-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6294133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management