Individual
MISS KELLY K LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
75 FRANCIS ST, BOSTON, MA 02115-6110
(781) 640-1542
Mailing address
76 CHILTON ST, CAMBRIDGE, MA 02138-6802
(781) 640-1542
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA3727
MA
Other
Enumeration date
02/04/2009
Last updated
12/04/2023
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