Individual
DR. JESSICA ROSE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5841 S MARYLAND AVE # MC2050, CHICAGO, IL 60637-1447
(773) 834-0598
Mailing address
10 CENTER DRIVE RM 8N248 MSC1840, BETHESDA, MD 20892-0001
(301) 435-6926
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
125070845
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125070845
LICENSE NUMBER
IL
Enumeration date
06/06/2017
Last updated
06/14/2021
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