Provider Demographics
NPI:1104185420
Name:LITTLE, GEOFFREY P (PA-C)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:P
Last Name:LITTLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BRYANTS SQ
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:GREENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12083-3413
Mailing Address - Country:US
Mailing Address - Phone:518-966-8786
Mailing Address - Fax:
Practice Address - Street 1:20 BRYANTS SQ
Practice Address - Street 2:APT/SUITE
Practice Address - City:GREENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12083-3413
Practice Address - Country:US
Practice Address - Phone:518-966-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000491-1207R00000X, 363A00000X, 363AM0700X, 363AS0400X
NY000-491-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical