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General NPI Number Information
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NPI Number | 1750465217
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Entity Type | Individual
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Provider Name | JOHN LONG MD
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/15/2007
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Provider Practice Location Address
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Address Line | 489 STATE ST
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City | BANGOR
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State | ME
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Zip | 04401-6616
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Country | US
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Telephone | 207-973-8305
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PROFESSIONAL DR
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8433
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Country | US
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Telephone |
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 008259
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 008259
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License Number State | ME
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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 | 008259
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 008259
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 008259
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License Number State | ME
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Taxonomy #6
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 008259
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License Number State | ME
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