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Individual
DR. MARY ANN LONG
Active
Individual
DR. MARY ANN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
193200000X
Multi-Specialty Group
Primary
21188
WV
207Q00000X
Family Medicine Physician
21188
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000059
—
WV
Enumeration date
08/31/2006
Last updated
09/22/2015
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