Provider Demographics
NPI:1154543692
Name:LONGIN, HEATHER MARIE (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:LONGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 FAULK ST
Practice Address - Street 2:STE 3100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5086
Practice Address - Country:US
Practice Address - Phone:704-667-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00157207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1154543692Medicaid
ILP00404454OtherRRMC-LOCALITY 16
IL1316998578OtherGROUP PRACTICE NPI
SCNC1534Medicaid
NC5919881Medicaid
ILK39873OtherMEDICARE PIN-LOCALITY 15
ILK39874OtherMEDICARE PIN-LOCALITY 16
IL1616378OtherBCBS
IL1616378OtherBCBS
NCNC5322BMedicare PIN