MEDICARE: DR. KATHERINE R 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	208000000X	Pediatrics Physician	MD25210	OR

General Provider Information

NPI Number	:	1932181013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE R LONG MD

Provider Business Mailing Address
First Line	:	444 NW ELKS DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-3745
Country	:	US
Telephone Number	:	541-754-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 NW SAMARITAN DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-3737
Country	:	US
Telephone Number	:	541-754-1150
Fax Number	:	541-754-1512

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	09/25/2025

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