Healthcare Provider Details

I. General information

NPI: 1205398997
Provider Name (Legal Business Name): DAVID EDWARD LONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 SHAWNEE RD STE 374
LIMA OH
45806-1444
US

IV. Provider business mailing address

9660 SUNRAY DR
OLMSTED TWP OH
44138-4253
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-8209
  • Fax: 419-222-6007
Mailing address:
  • Phone: 216-903-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.015455
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34.015455
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: