Provider Demographics
NPI:1427357284
Name:LITTLE, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNA
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5175 MORSE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1370
Mailing Address - Country:US
Mailing Address - Phone:614-741-4411
Mailing Address - Fax:614-741-4412
Practice Address - Street 1:5175 MORSE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1370
Practice Address - Country:US
Practice Address - Phone:614-741-4411
Practice Address - Fax:614-741-4412
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120610208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106121Medicaid