Healthcare Provider Details

I. General information

NPI: 1316943087
Provider Name (Legal Business Name): ROBERT GLENN LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 S ARLINGTON AVE
HARRISBURG PA
17109-5002
US

IV. Provider business mailing address

409 S 2ND ST SUITE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-5905
  • Fax: 717-782-5908
Mailing address:
  • Phone: 717-782-5905
  • Fax: 717-782-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD010182E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD010182E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: