Healthcare Provider Details

I. General information

NPI: 1396705703
Provider Name (Legal Business Name): ROBERT LITTLE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 RIDGEWAY AVE
ROCHESTER NY
14626-4114
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-2845
  • Fax: 585-723-6877
Mailing address:
  • Phone: 585-922-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number144014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: