Provider Demographics
NPI:1043245004
Name:LONGBINE, TIMOTHY W (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:W
Last Name:LONGBINE
Suffix:
Gender:M
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 12845
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052
Mailing Address - Country:US
Mailing Address - Phone:704-834-2825
Mailing Address - Fax:704-866-7853
Practice Address - Street 1:2525 COURT DRIVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-834-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601382207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133R3OtherBC
NC8912274Medicaid
SCN01382Medicaid
NC2277202BOtherMEDICARE
NC8912274Medicaid
SCN01382Medicaid
G96876Medicare UPIN