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General NPI Number Information
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NPI Number | 1356793806
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Entity Type | Individual
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Provider Name | ANDREA LITTLE MD, MBA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 2800 TAMARACK AVE STE 104
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-5553
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Country | US
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Telephone | 860-533-4692
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 TAMARACK AVE STE 104
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-5553
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Country | US
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Telephone | 860-522-4692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 70849
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 4301110548
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 70849
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License Number State | CT
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