Provider Demographics
NPI:1568400612
Name:LITTMAN, MARIO (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:LITTMAN
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 1:7300 CITY LINE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2218
Mailing Address - Country:US
Mailing Address - Phone:215-878-7050
Mailing Address - Fax:215-878-3951
Practice Address - Street 1:7300 CITY LINE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2218
Practice Address - Country:US
Practice Address - Phone:215-878-7050
Practice Address - Fax:215-878-3951
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 034443 E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1630918OtherBLUE SHIELD/PERSONAL CHOI
PA98580OtherAETNA
PA08535OtherHEALTH PARTNERS
PA0010575090003Medicaid
PA0045905000OtherKEYSTONE/KEYCARE/IBC
PA98580OtherAETNA
PA0010575090003Medicaid