Provider Demographics
NPI:1649334038
Name:LITTLEJOHN, JOHN D (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:LITTLEJOHN
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 1:4 BRUSHMEADE
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2720
Mailing Address - Country:US
Mailing Address - Phone:814-693-9767
Mailing Address - Fax:
Practice Address - Street 1:105 NASON DR
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1202
Practice Address - Country:US
Practice Address - Phone:814-224-5455
Practice Address - Fax:814-224-5004
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064555L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA215661OtherUPMC
PA411286OtherBLUE CROSS BLUE SHEILD
PA0016811220001Medicaid
PA1503911OtherGATEWAY
PA411286OtherBLUE CROSS BLUE SHEILD
PA0016811220001Medicaid