Healthcare Provider Details

I. General information

NPI: 1477698462
Provider Name (Legal Business Name): MARTHA C LITTLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 TOOKANY CREEK PKWY
CHELTENHAM PA
19012-1107
US

IV. Provider business mailing address

123 TOOKANY CREEK PKWY
CHELTENHAM PA
19012-1107
US

V. Phone/Fax

Practice location:
  • Phone: 215-635-0860
  • Fax: 215-635-1719
Mailing address:
  • Phone: 215-635-0860
  • Fax: 215-635-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD046077L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD046077L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: