MEDICARE: ERIC LEE LONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	88614	SC
2	208600000X	Surgery Physician	88614	SC

General Provider Information

NPI Number	:	1205013851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC LEE LONG MD

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	888-472-0043
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	3510 N HIGHWAY 17 STE 325
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-8232
Country	:	US
Telephone Number	:	843-723-2835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	08/25/2025

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Directions to “ ERIC LEE LONG MD” Practice Location

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