Healthcare Provider Details

I. General information

NPI: 1740275304
Provider Name (Legal Business Name): GEORGE ROBERT LITTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BRIDGE ST
NEW CUMBERLAND PA
17070-1127
US

IV. Provider business mailing address

1900 BRIDGE ST
NEW CUMBERLAND PA
17070-1127
US

V. Phone/Fax

Practice location:
  • Phone: 717-774-7041
  • Fax: 717-774-3213
Mailing address:
  • Phone: 717-774-7041
  • Fax: 717-774-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD007501E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: