Provider Demographics
NPI:1134306590
Name:LITTLE, VIJAYAVALLI (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYAVALLI
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WALTER REED BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3701
Mailing Address - Country:US
Mailing Address - Phone:972-487-5462
Mailing Address - Fax:
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5743
Practice Address - Country:US
Practice Address - Phone:972-487-5462
Practice Address - Fax:972-487-5277
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8798208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00813405 CD6866OtherMEDICARE RAILROAD
TXP00813405 CD6866OtherMEDICARE RAILROAD