Provider Demographics
NPI:1407977309
Name:GAVIN C. LITTLE, D.O., LLC
Entity Type:Organization
Organization Name:GAVIN C. LITTLE, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-462-3433
Mailing Address - Street 1:46 TOLL RD STE C
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-1435
Mailing Address - Country:US
Mailing Address - Phone:978-462-3433
Mailing Address - Fax:978-462-5876
Practice Address - Street 1:46 TOLL RD STE C
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-1435
Practice Address - Country:US
Practice Address - Phone:978-462-3433
Practice Address - Fax:978-462-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157794207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30233643Medicaid
MA9740660Medicaid
NH30233643Medicaid
MA9740660Medicaid