Provider Demographics
NPI:1568471670
Name:LITTLE, THERESA P (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:P
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:P
Other - Last Name:MELLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:725 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3568
Mailing Address - Country:US
Mailing Address - Phone:302-678-4488
Mailing Address - Fax:302-678-4497
Practice Address - Street 1:725 S QUEEN ST STE 4
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3568
Practice Address - Country:US
Practice Address - Phone:302-678-4488
Practice Address - Fax:302-678-4497
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000418201Medicaid
429498C05Medicare ID - Type Unspecified
DE0000418201Medicaid