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Individual

RANDALL R LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.PHD

Contact information

Practice address
590 COURT ST, KEENE, NH 03431-1719
(603) 354-5454
Mailing address
590 COURT ST, KEENE, NH 03431-1719
(603) 354-5454

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
45880
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0109185
MA
05
30208176
NH
Enumeration date
12/05/2005
Last updated
06/04/2012
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