MEDICARE: DR. JUDITH A. LONG M.D.

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	207R00000X	Internal Medicine Physician	MD-060790-L	PA

General Provider Information

NPI Number	:	1952312225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH A. LONG M.D.

Provider Business Mailing Address
First Line	:	423 GUARDIAN DRIVE
Second Line	:	1201 BLOCKLEY HALL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6021
Country	:	US
Telephone Number	:	215-898-4311
Fax Number	:	215-573-8778

Provider Business Practice Location Address
First Line	:	423 GUARDIAN DRIVE
Second Line	:	1201 BLOCKLEY HALL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6021
Country	:	US
Telephone Number	:	215-898-4311
Fax Number	:	215-573-8778

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	10/20/2015

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