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1841266608 NPI number — CHARLES A LONGO M.D.

NPI Number: 1841266608
Health Care Provider/Practitioner: CHARLES A LONGO M.D.

Information about “1841266608” NPI (CHARLES A LONGO M.D.) exists in 1841266608 in HTML format HTML  |  1841266608 in plain Text format TXT  |  1841266608 in PDF (Portable Document Format) PDF  |  1841266608 in an XML format XML  formats.

NPI Number : 1841266608 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841266608",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LONGO",
    "FirstName": "CHARLES",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2400 S MINNESOTA AVE",
    "SecondLineMailingAddress": "STE 100",
    "MailingAddressCityName": "SIOUX FALLS",
    "MailingAddressStateName": "SD",
    "MailingAddressPostalCode": "57105-3762",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "605-322-7510",
    "MailingAddressFaxNumber": "605-322-6475",
    "FirstLinePracticeLocationAddress": "1315 S. CLIFF AVE",
    "SecondLinePracticeLocationAddress": "STE 3000",
    "PracticeLocationAddressCityName": "SIOUX FALLS",
    "PracticeLocationAddressStateName": "SD",
    "PracticeLocationAddressPostalCode": "57105-1061",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "605-322-7600",
    "PracticeLocationAddressFaxNumber": "605-322-7601",
    "EnumerationDate": "02/23/2006",
    "LastUpdateDate": "12/13/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RE0101X",
        "TaxonomyName": "Endocrinology, Diabetes & Metabolism Physician",
        "LicenseNumber": "5192",
        "LicenseNumberStateCode": "SD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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