Healthcare Provider Details

I. General information

NPI: 1619955911
Provider Name (Legal Business Name): RICHARD LONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 ROSTRAVER RD
BELLE VERNON PA
15012-9655
US

IV. Provider business mailing address

1645 ROSTRAVER RD
BELLE VERNON PA
15012-9655
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-2640
  • Fax:
Mailing address:
  • Phone: 724-929-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD036822L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: