MEDICARE: LONG DERMATOLOGY PA

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	207N00000X	Dermatology Physician	ME68137	FL

General Provider Information

NPI Number	:	1801003496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG DERMATOLOGY PA

Provider Business Mailing Address
First Line	:	155 N NOVA RD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5138
Country	:	US
Telephone Number	:	386-672-3111
Fax Number	:	386-672-6532

Provider Business Practice Location Address
First Line	:	155 N NOVA RD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5138
Country	:	US
Telephone Number	:	386-672-3111
Fax Number	:	386-672-6532

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN C LONG JR.
Credential	:	MD
Telephone Number	:	386-672-3111

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	04/20/2008

Similar Medicare Providers

1356351043 — DR. JOHN CHARLES LONG JR. MD
Practice Location Address:

155 N NOVA RD
ORMOND BEACH, FL
32174-5138

Practice Phone: 386-672-3111
Practice Fax: 386-672-6532

1861687071 — ASSOCIATED DERMATOLOGIST PA
Practice Location Address:

155 N NOVA RD
ORMOND BEACH, FL
32174-5138

Practice Phone: 386-672-3111
Practice Fax:

1922253541 — BROWN AND CHMIELARSKI, D.M.D.,PA
Practice Location Address:

145 N NOVA RD
ORMOND BEACH, FL
32174-5138

Practice Phone: 386-677-1046
Practice Fax: 386-672-6741

1285104091 — DR. KIMBERLY ROSE DENNIS DMD
Practice Location Address:

145 N NOVA RD
ORMOND BEACH, FL
32174-5138

Practice Phone: 386-677-1046
Practice Fax: 386-672-6741

1306715834 — TDN DENTISTRY, PLLC
Practice Location Address:

145 N NOVA RD
ORMOND BEACH, FL
32174-5138

Practice Phone: 386-310-0130
Practice Fax:

1457340713 — DR. JESSE MANUEL VALENCIA PT,DC
Practice Location Address:

3535 E 7TH ST
LONG BEACH, CA
90804-5138

Practice Phone: 562-434-0062
Practice Fax: 562-439-4617

Directions to “LONG DERMATOLOGY PA ” Practice Location

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