Provider Demographics
NPI:1952452104
Name:LONGSHORE, KRISTINE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:LONGSHORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:410 FARM LN
Mailing Address - Street 2:CARRIAGE HOUSE
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4740
Mailing Address - Country:US
Mailing Address - Phone:215-348-4554
Mailing Address - Fax:215-348-4968
Practice Address - Street 1:410 FARM LN
Practice Address - Street 2:CARRIAGE HOUSE
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4740
Practice Address - Country:US
Practice Address - Phone:215-348-4554
Practice Address - Fax:215-348-4968
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD063813L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA031383SRQMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
PACE079016Medicare ID - Type UnspecifiedGROUP NUMBER
PAH03673Medicare UPIN