Healthcare Provider Details

I. General information

NPI: 1023762986
Provider Name (Legal Business Name): LONG INTEGRATED MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7652 BELAIR RD STE A
BALTIMORE MD
21236-4067
US

IV. Provider business mailing address

7652 BELAIR RD STE A
BALTIMORE MD
21236-4067
US

V. Phone/Fax

Practice location:
  • Phone: 410-508-0722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS CONDA
Title or Position: BILLING MANAGER
Credential:
Phone: 410-927-3510