MEDICARE: DR. CHAD STEWART LONG D.P.M.

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
1	213E00000X	Podiatrist	SC005979	PA

General Provider Information

NPI Number	:	1578760658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD STEWART LONG D.P.M.

Provider Business Mailing Address
First Line	:	933 N CHARLOTTE ST
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-3974
Country	:	US
Telephone Number	:	610-326-4367
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 N CHARLOTTE ST
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-3974
Country	:	US
Telephone Number	:	610-326-4367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	02/27/2012

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