Individual
MARY L LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2014 WASHINGTON ST, NEWTON, MA 02462-1607
(617) 243-6298
Mailing address
2014 WASHINGTON ST, NEWTON, MA 02462-1607
(617) 243-6298
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
56375
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110053366A
—
MA
Enumeration date
06/06/2006
Last updated
03/09/2022
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