Provider Demographics
NPI:1033489273
Name:LONGO, MARIA T (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:LONGO
Suffix:
Gender:F
Credentials:PA
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 824301
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4031
Mailing Address - Country:US
Mailing Address - Phone:781-280-1500
Mailing Address - Fax:781-276-6410
Practice Address - Street 1:1572 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8371
Practice Address - Country:US
Practice Address - Phone:610-459-3278
Practice Address - Fax:781-276-6410
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant