Healthcare Provider Details

I. General information

NPI: 1679138002
Provider Name (Legal Business Name): VICTOR LONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

5705 FIVE SISTERS CT
FAYETTEVILLE NC
28311-0235
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-5095
  • Fax:
Mailing address:
  • Phone: 908-720-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023-00006
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number202300006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: