Individual
TERESA CHARL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
240 PARSONS AVE, COLUMBUS, OH 43215-5331
(614) 645-7417
Mailing address
240 PARSONS AVE, COLUMBUS, OH 43215-5331
(614) 645-7417
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
35-054074
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2439730
—
OH
01
—
316400223035
CARESOURCE CLINIC #
OH
Enumeration date
07/17/2006
Last updated
07/24/2012
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