Provider Demographics
NPI:1962491373
Name:LITTLE, MARTA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:MARIE
Last Name:LITTLE
Suffix:
Gender:F
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:DEPT. 453 PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:1100 6TH ST STE 203
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1757
Practice Address - Country:US
Practice Address - Phone:319-339-3850
Practice Address - Fax:319-339-3871
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24377207RA0201X
IAMD-24377207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB3947001OtherMEDICARE PTAN
IA1962491373Medicaid
IA0217711Medicaid
IA46328OtherWELLMARK BCBS
IA0217711Medicaid
IA1217711Medicaid