Provider Demographics
NPI:1598702284
Name:LITLE, VIRGINIA R (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:R
Last Name:LITLE
Suffix:
Gender:F
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:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:415-537-8600
Mailing Address - Fax:415-369-1371
Practice Address - Street 1:1100 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6978
Practice Address - Country:US
Practice Address - Phone:415-537-8600
Practice Address - Fax:415-369-1371
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74440208G00000X
MA253822208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02202266Medicaid
MA110094781AMedicaid
MA003065101Medicare PIN
NYJ400025567Medicare PIN
MA110094781AMedicaid