Provider Demographics
NPI:1417196411
Name:LITTLE, CARA-LEA PEARL (PA)
Entity Type:Individual
Prefix:
First Name:CARA-LEA
Middle Name:PEARL
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 CARRIAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7313
Mailing Address - Country:US
Mailing Address - Phone:703-955-6118
Mailing Address - Fax:240-826-7040
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:240-826-7072
Practice Address - Fax:240-826-7040
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002959363A00000X
MDC0004225363AS0400X
TN2277363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417196411Medicaid
TN4343921OtherBCBS - PA ASSIST SURGERY
TN9250991OtherAETNA
TNQ000472Medicaid
TN4343919OtherBLUECROSS BLUESHIELD
TNP01281383OtherRAILROAD MEDICARE
VA1417196411Medicaid
VAMC12779Medicare PIN
TN4343919OtherBLUECROSS BLUESHIELD