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NPI Code Detail

MEDICARE: MR. SCOTT DAVID LONG PA-C

MEDICARE: MR. SCOTT DAVID LONG PA-C
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
1363A00000XPhysician Assistant103319NC

General Provider Information

NPI Number : 1477659506
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT DAVID LONG PA-C
Provider Business Mailing Address
First Line : 1021 DARRINGTON DR STE 101
Second Line :
City : CARY
State : NC
Zip : 27513-8158
Country : US
Telephone Number : 843-332-7419
Fax Number : 919-378-9114
Provider Business Practice Location Address
First Line : 1309 LEES CHAPEL RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2601
Country : US
Telephone Number : 336-800-8958
Fax Number : 336-286-5583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 11/07/2023

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Directions to “ MR. SCOTT DAVID LONG PA-C” Practice Location

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