Healthcare Provider Details

I. General information

NPI: 1780630749
Provider Name (Legal Business Name): CHRISTOPHER ROBERT LONGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 BENSON DRIVE, SUITE 201 CAROLINA VASCULAR SURGERY & DIAGNOSTICS, PA
RALEIGH NC
27609-7372
US

IV. Provider business mailing address

3713 BENSON DRIVE SUITE 201
RALEIGH NC
27609-7372
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-3400
  • Fax: 919-235-3401
Mailing address:
  • Phone: 919-235-3400
  • Fax: 919-235-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number430618
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number200600954
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: