Provider Demographics
NPI:1568801298
Name:LONG, KATIE JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JANE
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:JANE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:916-933-8010
Mailing Address - Fax:
Practice Address - Street 1:5137 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9670
Practice Address - Country:US
Practice Address - Phone:916-933-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1332572080A0000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine