Provider Demographics
NPI:1629001862
Name:LITTON, DARLENE B (MD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:B
Last Name:LITTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:410 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-8359
Practice Address - Country:US
Practice Address - Phone:276-466-0584
Practice Address - Fax:276-669-8583
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101027068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010070988Medicaid
TN1514316Medicaid
TN1514316Medicaid
VA00V965H01Medicare PIN
VA019903W82Medicare PIN
VAV V5978AMedicare PIN