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General NPI Number Information
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NPI Number | 1043208523
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Entity Type | Individual
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Provider Name | MOLLY M LONG MD
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Gender | Female
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 603 7TH ST S SUITE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4719
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Country | US
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Telephone | 727-954-7121
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Fax | 727-954-7122
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Provider Business Mailing Address
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Address Line | PO BOX 25317
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City | TAMPA
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State | FL
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Zip | 33622-5317
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Country | US
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Telephone | 813-286-0033
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Fax | 813-282-1806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME00752014
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License Number State | FL
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