Healthcare Provider Details

I. General information

NPI: 1457510695
Provider Name (Legal Business Name): PATRICE MARIE CATES LONBERGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W FAIRBANKS AVE
WINTER PARK FL
32789-4720
US

IV. Provider business mailing address

1111 W FAIRBANKS AVE
WINTER PARK FL
32789-4720
US

V. Phone/Fax

Practice location:
  • Phone: 407-660-7150
  • Fax: 407-660-7108
Mailing address:
  • Phone: 407-635-5565
  • Fax: 321-842-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01068539
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01068539
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME143610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: