Provider Demographics
NPI:1063825248
Name:LONGO, KATHERINE CUSACK (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CUSACK
Last Name:LONGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE APT 603
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3809
Mailing Address - Country:US
Mailing Address - Phone:309-264-1315
Mailing Address - Fax:
Practice Address - Street 1:UW HOSPITALS AND CLINICS
Practice Address - Street 2:600 HIGHLAND AVE
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:309-264-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66844-202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology