1538148432 NPI number — DR. ROBERT M LITT M.D.

Table of content: DR. ROBERT M LITT M.D. (NPI 1538148432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538148432 NPI number — DR. ROBERT M LITT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITT
Provider First Name:
ROBERT
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538148432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 WAGON TRAIL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89118-4426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-942-4123
Provider Business Mailing Address Fax Number:
702-942-4124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3061 S MARYLAND PKWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-731-2888
Provider Business Practice Location Address Fax Number:
702-696-9289
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  4046 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NV4046 . This is a "BLUE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 200290204 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116368600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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