Provider Demographics
NPI:1063476299
Name:CARLSON-LITTLE, TAMMY E (DPM)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:E
Last Name:CARLSON-LITTLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1929
Mailing Address - Country:US
Mailing Address - Phone:814-643-1720
Mailing Address - Fax:814-643-4953
Practice Address - Street 1:1201 MOORE ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1826
Practice Address - Country:US
Practice Address - Phone:814-643-1720
Practice Address - Fax:814-643-4953
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005522213E00000X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019606750001Medicaid
P00278620OtherTRAVELERS MEDICARE
PA01489224OtherBLUE SHIELD
0007621509OtherAETNA
323538OtherUPMC HEALTH PLAN
323538OtherUPMC HEALTH PLAN
0007621509OtherAETNA