MEDICARE: MICHAEL TYREK LONG

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	3747P1801X	Personal Care Attendant		DC

General Provider Information

NPI Number	:	1609733187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TYREK LONG

Provider Business Mailing Address
First Line	:	1410 DELAFIELD PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4347
Country	:	US
Telephone Number	:	202-860-9409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1369 IRVING ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2312
Country	:	US
Telephone Number	:	202-883-9751
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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