Russell Longendorfer, PA-C
Physician Assistant in Worcester, MA. Individual provider (NPI-1).
NPI number1194249136
StatusActive
Last updated in NPPESApr 21, 2022
Details
- NPI
- 1194249136
- Entity type
- Individual (NPI-1)
- Name
- Russell Longendorfer
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 1, 2017
- Certification date
- Apr 21, 2022
- Last updated
- Apr 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA8684 | MA | Yes |
| 363A00000X | Physician Assistant | – | – | |
| 363A00000X | Physician Assistant | 3945 | CT |
Practice location
55 Lake Ave NWorcester, MA 01655-0002
Phone 774-443-7552 · Fax 774-441-6086
Mailing address
Po Box 415348Boston, MA 02241-5348
Phone 800-225-8885
Other practice locations
80 Seymour St
Hartford, CT 06106-3315
Hartford, CT 06106-3315
Phone 508-851-0809
119 Belmont St
Worcester, MA 01605-2903
Worcester, MA 01605-2903
Phone 774-443-7552 · Fax 774-441-6086
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