Provider Demographics
NPI:1477680643
Name:LITTLEJOHN, EDWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:LITTLEJOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DARDANELLI LN STE 10
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-412-8100
Mailing Address - Fax:408-412-8499
Practice Address - Street 1:340 DARDANELLI LN STE 10
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1418
Practice Address - Country:US
Practice Address - Phone:408-358-2757
Practice Address - Fax:408-358-2089
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G441010Medicare ID - Type Unspecified
CAA49551Medicare UPIN