Provider Demographics
NPI:1699006668
Name:LONGANO, LISA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LOUISE
Last Name:LONGANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LOUISE
Other - Last Name:ANDERSON LONGANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9601 BUJACICH RD NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8300
Mailing Address - Country:US
Mailing Address - Phone:253-858-4266
Mailing Address - Fax:253-858-4258
Practice Address - Street 1:9601 BUJACICH RD NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8300
Practice Address - Country:US
Practice Address - Phone:253-858-4266
Practice Address - Fax:253-858-4258
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60021343208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics