Individual
DR. CODY MICHAEL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6130
(215) 829-5410
Mailing address
305 S 11TH ST APT 1R, PHILADELPHIA, PA 19107-6094
(856) 417-1859
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/30/2020
Last updated
03/30/2020
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