Healthcare Provider Details

I. General information

NPI: 1841200466
Provider Name (Legal Business Name): LANA L LONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEST 4TH STREET SUITE 2200
CINCINNATI OH
45202
US

IV. Provider business mailing address

1 WEST 4TH STREET SUITE 2200
CINCINNATI OH
45202
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-3376
  • Fax: 513-618-2128
Mailing address:
  • Phone: 513-421-3376
  • Fax: 513-618-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35-068727
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number31630
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.068727
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: