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General NPI Number Information
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NPI Number | 1013437268
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE LONGO DO
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 2987 DISTRICT AVE STE 120
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City | FAIRFAX
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State | VA
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Zip | 22031-1571
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Country | US
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Telephone | 888-663-6331
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 697 LOUISIANA RD
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City | DYESS AFB
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State | TX
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Zip | 79607-1141
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Country | US
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Telephone | 325-696-4677
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Fax | 325-696-3320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 1946
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7934
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102208415
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License Number State | VA
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