Provider Demographics
NPI:1689157331
Name:LONGTCHI, GEDEON (FNP)
Entity Type:Individual
Prefix:MR
First Name:GEDEON
Middle Name:
Last Name:LONGTCHI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 VINEYARD LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1116
Mailing Address - Country:US
Mailing Address - Phone:240-353-2357
Mailing Address - Fax:
Practice Address - Street 1:2454 VINEYARD LN
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1116
Practice Address - Country:US
Practice Address - Phone:240-353-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1026502363LF0000X
MDR199900363LF0000X
MDR162583363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1689157331Medicaid