Provider Demographics
NPI:1437971413
Name:LITTLE OAK PEDIATRICS LLC
Entity type:Organization
Organization Name:LITTLE OAK PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:850-384-1353
Mailing Address - Street 1:7652 BELAIR RD STE A
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4067
Mailing Address - Country:US
Mailing Address - Phone:443-524-2712
Mailing Address - Fax:443-399-1282
Practice Address - Street 1:7652 BELAIR RD STE A
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4067
Practice Address - Country:US
Practice Address - Phone:443-524-2713
Practice Address - Fax:443-399-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD051520300Medicaid