Healthcare Provider Details

I. General information

NPI: 1942525324
Provider Name (Legal Business Name): JESSICA MCGUIRE LONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MASSACHUSETTS AVE NW
WASHINGTON DC
20016-4358
US

IV. Provider business mailing address

4900 MASSACHUSETTS AVENUE NW
WASHINGTON DC
20016
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-5000
  • Fax: 202-966-3830
Mailing address:
  • Phone: 202-966-5000
  • Fax: 202-966-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD041707
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: