Provider Demographics
NPI:1427077726
Name:LITTLE, RAYMOND ROGER (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ROGER
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 STONE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3904
Mailing Address - Country:US
Mailing Address - Phone:740-607-4511
Mailing Address - Fax:740-454-5385
Practice Address - Street 1:2590 STONE CREEK CIR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3904
Practice Address - Country:US
Practice Address - Phone:740-607-4511
Practice Address - Fax:740-454-5385
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 059644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist