Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD433918 | PA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD433918 | PA |
N | 207VX0201X | Gynecologic Oncologist | 34110 | AZ |
NPI | 1952386195 |
---|---|
Provider Name | Dr. Jaime B Long |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 11/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010213023 | (05) | PA |
127992 | MEDICARE (01) | PA |
86080015085259C450 | TRIWEST (01) | AZ |
939754 | (05) | AZ |
I35527 | (02) | |
P00272876 | RAILROAD MEDICARE (01) | AZ |
P00670380 | RAILROAD MEDICARE - READING PROFESSIONAL SERVICES (01) | PA |