Healthcare Provider Details

I. General information

NPI: 1013971654
Provider Name (Legal Business Name): RONALD MORGAN LONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 PARKWAY DR SUITE C
GOLDSBORO NC
27534-9432
US

IV. Provider business mailing address

1208 PARKWAY DR STE C
GOLDSBORO NC
27534-9432
US

V. Phone/Fax

Practice location:
  • Phone: 919-751-8444
  • Fax: 919-751-0890
Mailing address:
  • Phone: 919-751-8444
  • Fax: 919-751-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number28258
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: