Provider Demographics
NPI:1639139579
Name:LITTLE, DONALD F (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:F
Last Name:LITTLE
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 1:1718 E 4TH ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3260
Mailing Address - Country:US
Mailing Address - Phone:704-334-7799
Mailing Address - Fax:704-333-5930
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 601
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3260
Practice Address - Country:US
Practice Address - Phone:704-334-7799
Practice Address - Fax:704-333-5930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952108Medicaid
NC8952108Medicaid
NC2309642Medicare ID - Type UnspecifiedMEDICARE ID