Individual
EMMA L. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1500 PROVIDENT DR, SUITE A, WARSAW, IN 46580-3291
(574) 372-7637
Mailing address
1500 PROVIDENT DR, SUITE A, WARSAW, IN 46580-3291
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01045980A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000241419
ANTHEM
IN
05
—
200141330
—
IN
01
—
5061595
AETNA
—
01
—
5887
PHYSICIANS HEALTH PLAN
IN
Enumeration date
12/27/2005
Last updated
06/24/2013
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