Individual
DEANDRE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
574 GLENDORA AVE, AKRON, OH 44320-1965
(330) 415-2202
Mailing address
574 GLENDORA AVE, AKRON, OH 44320-1965
(330) 415-2202
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78689695
—
OH
Enumeration date
01/03/2023
Last updated
01/03/2023
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