Provider Demographics
NPI:1225032592
Name:LONGABAUGH, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:LONGABAUGH
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 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-842-3042
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3042
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060289207RC0000X
OH35082841L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00711890OtherRRMC
MIP00812603OtherRRMC
OH2478233Medicaid
CK5518Medicare PIN
MI0N23450Medicare PIN
OH4126021Medicare PIN
OHP00089900Medicare PIN
C87554Medicare UPIN
OH4126025Medicare PIN
MIMI1635004Medicare PIN
P00089900Medicare PIN
OH4114271Medicare PIN
OH2478233Medicaid
OH4114276Medicare PIN
OH4114275Medicare PIN
OHCF7396Medicare PIN
OHLO4126027Medicare PIN
MI001743461Medicare UPIN
MIP00812603OtherRRMC
MI23450007Medicare PIN