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General NPI Number Information
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NPI Number | 1659265585
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Entity Type | Individual
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Provider Name | BRIAN LONG PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 6710A ROCKLEDGE DR STE 130
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City | BETHESDA
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State | MD
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Zip | 20817-2843
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Country | US
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Telephone | 301-515-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 14414 SENECA RD
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City | DARNESTOWN
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State | MD
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Zip | 20874-3332
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Country | US
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Telephone | 301-768-2804
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0009947
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License Number State | MD
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