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General NPI Number Information
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NPI Number | 1679747265
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Entity Type | Individual
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Provider Name | ANDREW WALLAYS LONG MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 677 N WILMOT RD
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City | TUCSON
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State | AZ
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Zip | 85711-2701
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Country | US
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Telephone | 520-733-7226
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Fax | 520-795-6321
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Provider Business Mailing Address
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Address Line | 725 NORTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-4109
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Country | US
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Telephone | 413-447-2439
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Fax | 413-496-6869
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | D71136
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 274986
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 78295
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License Number State | AZ
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