Individual
PHILLIP B. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5289
(740) 446-5697
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5289
(740) 446-5697
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
18423
WV
2085R0202X
Diagnostic Radiology Physician
Primary
35-06-2892
OH
2085R0204X
Vascular & Interventional Radiology Physician
18423
WV
2085R0204X
Vascular & Interventional Radiology Physician
35.062892
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006828
ANTHEM BCBS
—
01
—
000000190752
UNISON MEDICAID
OH
01
—
001714084
MOUNTAIN STATE BCBS
—
05
—
0120547000
—
WV
01
—
0969797
MOLINA MEDICAID
OH
05
—
0969797
—
OH
05
—
1770520330
—
KY
01
—
940000116
RR MEDICARE
—
Enumeration date
06/01/2006
Last updated
01/21/2021
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