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NPI Code Detail

MEDICARE: GERALD J. LONGA M.D.

MEDICARE: GERALD J. LONGA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist01034781IN

General Provider Information

NPI Number : 1780687921
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALD J. LONGA M.D.
Provider Business Mailing Address
First Line : PO BOX 1054
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47808-1054
Country : US
Telephone Number : 812-232-9557
Fax Number : 812-232-1517
Provider Business Practice Location Address
First Line : 1606 N 7TH ST
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47804-2706
Country : US
Telephone Number : 812-232-9557
Fax Number : 812-232-1517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/08/2007

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