Healthcare Provider Details

I. General information

NPI: 1528565066
Provider Name (Legal Business Name): VIRGINIA LONG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW FL 3.5
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3440
  • Fax:
Mailing address:
  • Phone: 202-476-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO035016
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: