Provider Demographics
NPI:1326039272
Name:LONGE, HAROLD O (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:O
Last Name:LONGE
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10212 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9705
Practice Address - Country:US
Practice Address - Phone:317-841-5656
Practice Address - Fax:317-841-5751
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066368A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01210561OtherRAILROAD MEDICARE
MA2006898Medicaid
MA2006898Medicaid
INM400056854Medicare PIN
INP01210561OtherRAILROAD MEDICARE
MAA22549Medicare ID - Type Unspecified