Healthcare Provider Details

I. General information

NPI: 1063421071
Provider Name (Legal Business Name): BRIAN SCOTT DELONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E MAIN ST
ANNVILLE PA
17003
US

IV. Provider business mailing address

1251 E MAIN ST
ANNVILLE PA
17003-1643
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-0570
  • Fax: 717-232-8152
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD031602E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD031602E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: