Healthcare Provider Details

I. General information

NPI: 1952303471
Provider Name (Legal Business Name): GREGORY SCOTT LONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/12/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E NORTH AVE LEVEL ONE
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

247 MOREWOOD AVE
PITTSBURGH PA
15213-1861
US

V. Phone/Fax

Practice location:
  • Phone: 123-255-7004
  • Fax:
Mailing address:
  • Phone: 412-622-0290
  • Fax: 412-681-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD052927L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: