Individual
JOHN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
489 STATE ST, BANGOR, ME 04401-6616
(207) 973-8305
Mailing address
300 PROFESSIONAL DR, SCARBOROUGH, ME 04074-8433
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
008259
ME
2085N0700X
Neuroradiology Physician
008259
ME
2085R0202X
Diagnostic Radiology Physician
Primary
008259
ME
2085R0203X
Therapeutic Radiology Physician
008259
ME
2085R0204X
Vascular & Interventional Radiology Physician
008259
ME
2085U0001X
Diagnostic Ultrasound Physician
008259
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024275
ANTHEM
ME
01
—
2323437
AETNA
ME
01
—
C66140
HPHC
ME
01
—
M80673
CIGNA
ME
Enumeration date
10/24/2006
Last updated
07/15/2007
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