Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC005522 | PA |
Y | 222Z00000X | Podiatrist | SC005522 | PA |
N | 111NR0200X | Radiology | SC005522 | PA |
N | 213ER0200X | Radiology | SC005522 | PA |
N | 2081S0010X | Sports Medicine | SC005522 | PA |
N | 213ES0000X | Sports Medicine | SC005522 | PA |
N | 213ES0103X | Foot & Ankle Surgery | SC005522 | PA |
N | 213ES0131X | Foot Surgery | SC005522 | PA |
NPI | 1063476299 |
---|---|
Provider Name | Ms. Tammy E. Carlson-Little |
First Address | Huntingdon, PA 16652-1929 |
Second Address | Huntingdon, PA 16652-1826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 15/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007621509 | AETNA (01) | |
0019606750001 | (05) | PA |
01489224 | BLUE SHIELD (01) | PA |
323538 | UPMC HEALTH PLAN (01) | |
P00278620 | TRAVELERS MEDICARE (01) | |
U94233 | (02) | PA |