Provider Demographics
NPI:1073738365
Name:LONGO, CHARLES THOMS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMS
Last Name:LONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4250 H ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3441
Mailing Address - Country:US
Mailing Address - Phone:916-456-8756
Mailing Address - Fax:916-456-1542
Practice Address - Street 1:4250 H ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3441
Practice Address - Country:US
Practice Address - Phone:916-456-8756
Practice Address - Fax:916-456-1542
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA355212086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery