Provider Demographics
NPI:1285028126
Name:LONGO-IMEDIO, MARIA ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ISABEL
Last Name:LONGO-IMEDIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ISABEL
Other - Last Name:LONGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:MC CA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-1159
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:303 BENNER PIKE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7304
Practice Address - Country:US
Practice Address - Phone:814-272-5660
Practice Address - Fax:814-272-5675
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD486832207N00000X
ZZ282851828207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015478700Medicaid
FL015478700Medicaid