Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD010182E | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD010182E | PA |
NPI | 1316943087 |
---|---|
Provider Name | Dr. Robert Glenn Little |
First Address | Harrisburg, PA 17104-1612 |
Second Address | Harrisburg, PA 17109-5002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0626467 | (05) | PA |
C31970 | (02) | PA |