Provider Demographics
NPI:1356793806
Name:LITTLE, ANDREA (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 TAMARACK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-5553
Mailing Address - Country:US
Mailing Address - Phone:860-522-4692
Mailing Address - Fax:
Practice Address - Street 1:2800 TAMARACK AVE STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5553
Practice Address - Country:US
Practice Address - Phone:860-533-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70849207XS0106X, 208200000X
MI4301110548208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery