Provider Demographics
NPI:1285028126
Name:LONGO-IMEDIO, MARIA ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ISABEL
Last Name:LONGO-IMEDIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ISABEL
Other - Last Name:LONGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4037 NW 86TH TER
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-9277
Mailing Address - Country:US
Mailing Address - Phone:352-594-1500
Mailing Address - Fax:352-594-1501
Practice Address - Street 1:4037 NW 86TH TER
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9277
Practice Address - Country:US
Practice Address - Phone:352-594-1500
Practice Address - Fax:352-594-1501
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ282851828207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015478700Medicaid
FL015478700Medicaid