Individual
CHARLES DAVID LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 GREENWOOD AVE, STE 14, JENKINTOWN, PA 19046-2902
(215) 572-6888
(215) 572-5905
Mailing address
1250 GREENWOOD AVE, STE 14, JENKINTOWN, PA 19046-2902
(215) 572-6888
(215) 572-5905
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD043562L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016511000
KEYSTONE HEALTH PLAN EAST
PA
05
—
0018274790004
—
PA
01
—
043791 - GROUP
MEDICARE
PA
01
—
052949
PERSONAL CHOICE GRP
PA
01
—
867646
PERSONAL CHOICE
PA
Enumeration date
05/23/2006
Last updated
05/23/2011
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