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General NPI Number Information
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NPI Number | 1689157331
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Entity Type | Individual
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Provider Name | GEDEON LONGTCHI FNP
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Gender | Male
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 2454 VINEYARD LN
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City | CROFTON
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State | MD
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Zip | 21114-1116
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Country | US
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Telephone | 240-353-2357
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Fax |
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Provider Business Mailing Address
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Address Line | 2454 VINEYARD LN
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City | CROFTON
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State | MD
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Zip | 21114-1116
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Country | US
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Telephone | 240-353-2357
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN1026502
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R199900
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R162583
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License Number State | MD
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