Provider Demographics
NPI:1881715787
Name:LONGOBARDO, CARLO (DC)
Entity type:Individual
Prefix:DR
First Name:CARLO
Middle Name:
Last Name:LONGOBARDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CHANDLER ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3314
Mailing Address - Country:US
Mailing Address - Phone:508-795-1810
Mailing Address - Fax:508-795-1282
Practice Address - Street 1:372 CHANDLER ST STE 102
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3314
Practice Address - Country:US
Practice Address - Phone:508-795-1810
Practice Address - Fax:508-795-1282
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA-2086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALOY45587Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
MAPAY49099Medicare ID - Type UnspecifiedGROUP #
MA93508Medicare UPIN