Healthcare Provider Details

I. General information

NPI: 1841254778
Provider Name (Legal Business Name): ANDREW WAYNE LITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 HANSEN RD NE
BAINBRIDGE ISLAND WA
98110-1614
US

IV. Provider business mailing address

7733 HANSEN RD NE
BAINBRIDGE ISLAND WA
98110-1614
US

V. Phone/Fax

Practice location:
  • Phone: 917-613-4536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number159319
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number159319
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: