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NPI Code Detail

MEDICARE: BRENT M LONG P.A.

MEDICARE: BRENT M LONG P.A.
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
1363A00000XPhysician Assistant1501096KS
2363AM0700XMedical Physician AssistantMA001513LPA
3363AM0700XMedical Physician Assistant1501096KS
4363AS0400XSurgical Physician Assistant1501096KS
5363A00000XPhysician AssistantOA002700PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508808528
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT M LONG P.A.
Provider Business Mailing Address
First Line : 2401 PARK DR
Second Line : STE 101
City : HARRISBURG
State : PA
Zip : 17110-9303
Country : US
Telephone Number : 610-367-2259
Fax Number : 610-367-0505
Provider Business Practice Location Address
First Line : 2401 PARK DR STE 101
Second Line :
City : HARRISBURG
State : PA
Zip : 17110-9303
Country : US
Telephone Number : 717-686-9842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 04/29/2022

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Directions to “ BRENT M LONG P.A.” Practice Location

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