Provider Demographics
NPI:1194700799
Name:LITTLE, EDWIN P (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:P
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 DOCTORS DRIVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501
Mailing Address - Country:US
Mailing Address - Phone:252-559-2200
Mailing Address - Fax:252-522-9778
Practice Address - Street 1:103 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PINK HILL
Practice Address - State:NC
Practice Address - Zip Code:28572
Practice Address - Country:US
Practice Address - Phone:252-568-4111
Practice Address - Fax:252-568-6396
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952114Medicaid
080184258OtherRAILROAD MEDICARE
202887FMedicare ID - Type Unspecified
NC8952114Medicaid