Individual
PHILLIP B. LONG
Active
Individual
PHILLIP B. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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