Organization
SUBURBAN PLASTIC SURGEONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DAVID LONG MD (PRES OWNER)
(215) 572-6888
Entity
Organization
Contact information
Practice address
1250 GREENWOOD AVE, SUITE 14, JENKINTOWN, PA 19046-2902
(215) 572-6888
(215) 572-5905
Mailing address
1250 GREENWOOD AVE, SUITE 14, JENKINTOWN, PA 19046-2902
(215) 572-6888
(215) 572-5905
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD043562L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016511000
KEYSTONE HEALTH PLAN
—
05
—
0018274790004
—
PA
01
—
052949
BLUE SHIELD
—
Enumeration date
05/22/2006
Last updated
06/17/2010
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