Provider Demographics
NPI:1295067775
Name:LITTLEPAGE, MEAGAN MARIE (MD)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:MARIE
Last Name:LITTLEPAGE
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 1:4604 WHITWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1759
Mailing Address - Country:US
Mailing Address - Phone:408-705-0114
Mailing Address - Fax:
Practice Address - Street 1:355 DARDANELLI LANE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-866-4036
Practice Address - Fax:408-871-7491
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108647208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation