Provider Demographics
NPI:1669651816
Name:LITTLE, LARRY J (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
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 1:71 S TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1355
Mailing Address - Country:US
Mailing Address - Phone:740-281-3205
Mailing Address - Fax:740-281-3743
Practice Address - Street 1:71 S TERRACE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1355
Practice Address - Country:US
Practice Address - Phone:740-281-3205
Practice Address - Fax:740-281-3743
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047090207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0476435Medicaid
A01490Medicare UPIN
OH0476435Medicaid
OH9359291Medicare PIN