Individual
MADELEINE GINETTE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2300 MACCORKLE AVE SE, CHARLESTON, WV 25304-1045
(800) 995-4682
Mailing address
416 ABBY DR, CHARLESTON, WV 25314-2423
(304) 993-4470
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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