Healthcare Provider Details

I. General information

NPI: 1013437268
Provider Name (Legal Business Name): CHRISTINE MARIE LONGO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2987 DISTRICT AVE STE 120
FAIRFAX VA
22031-1571
US

IV. Provider business mailing address

697 LOUISIANA RD
DYESS AFB TX
79607-1141
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 325-696-4677
  • Fax: 325-696-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1946
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7934
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102208415
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: