Provider Demographics
NPI:1366450314
Name:LONGA, CAROLINA BACANI (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:BACANI
Last Name:LONGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 INDEPENDENCE CIRCLE
Mailing Address - Street 2:STE 1-B
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-499-9504
Mailing Address - Fax:757-499-9504
Practice Address - Street 1:700 INDEPENDENCE CIRCLE
Practice Address - Street 2:STE 1-B
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-499-9504
Practice Address - Fax:757-499-9504
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA031680207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6087736Medicaid
B05847Medicare UPIN