Healthcare Provider Details

I. General information

NPI: 1760430581
Provider Name (Legal Business Name): DAVID LONGO CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7686 RICHMOND HWY STE 110
ALEXANDRIA VA
22306-2800
US

IV. Provider business mailing address

4703 LAWRENCE ST
ALEXANDRIA VA
22309-1115
US

V. Phone/Fax

Practice location:
  • Phone: 667-210-2149
  • Fax: 667-210-2167
Mailing address:
  • Phone: 667-210-2149
  • Fax: 667-210-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCPO0214
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02014
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02014
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02014
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02014
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: