Provider Demographics
NPI:1174606156
Name:LONGOBARDO, JOHN JOSEPH (DPM, MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:LONGOBARDO
Suffix:
Gender:M
Credentials:DPM, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4107
Mailing Address - Country:US
Mailing Address - Phone:704-588-7373
Mailing Address - Fax:704-872-3390
Practice Address - Street 1:531 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4107
Practice Address - Country:US
Practice Address - Phone:704-872-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC263077OtherWELLPATH
NC41856OtherPARTNERS PROVIDER NUMBER
NC890857HMedicaid
SCPD3204Medicaid
NC22677OtherMEDICAOST PROVIDER NUMBER
NC2741683OtherUNITED HEALTH CARE #
NC342391OtherCIGNA
NC4235524OtherAETNA PPO/POS
NC56412OtherPHCS PROVIDER NUMBER
NC34811OtherPRINCIPAL PROVIDER NUMBER
NC0857HOtherNC BXBS PROVIDER NUMBER
NC2023286OtherAETNA HMO PROVIDER NUMBER
NC2432155CMedicare PIN
NC263077OtherWELLPATH