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General NPI Number Information
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NPI Number | 1235323023
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Entity Type | Organization
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Legal Business Name | LONGWOOD MEDICAL GROUP PA
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 450 W STATE ROAD 434 STE 301
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City | LONGWOOD
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State | FL
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Zip | 32750-5187
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Country | US
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Telephone | 407-767-8200
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Fax | 407-767-0476
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Provider Business Mailing Address
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Address Line | 450 W STATE RD 434 STE 301
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City | LONGWOOD
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State | FL
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Zip | 32750
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Country | US
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Telephone | 407-767-8200
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Fax | 407-767-0476
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Authorized Official
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Title or Position | BILLING OFFICE SUPERVISOR
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Name | MS. ALISA MARIE CHARACTER
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Credential |
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Telephone | 407-767-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME79324
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME78066
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License Number State | FL
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