Provider Demographics
NPI:1558499046
Name:AAA FAMILY FOOT CARE CENTER,PLLC
Entity Type:Organization
Organization Name:AAA FAMILY FOOT CARE CENTER,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYHSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGOBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,MD
Authorized Official - Phone:704-588-7373
Mailing Address - Street 1:9124 S TRYON ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3114
Mailing Address - Country:US
Mailing Address - Phone:704-588-7373
Mailing Address - Fax:704-588-7585
Practice Address - Street 1:9124 S TRYON ST
Practice Address - Street 2:SUITE J
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3114
Practice Address - Country:US
Practice Address - Phone:704-588-7373
Practice Address - Fax:704-588-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPD3204Medicaid
NC890857HMedicaid
NC890857HMedicaid
NC2432155CMedicare PIN