Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 0101052923 | VA |
NPI | 1003916859 |
---|---|
Provider Name | Dr. Todd J Long |
First Address | Fishersville, VA 22939-2344 |
Second Address | Charlottesville, VA 22901-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 07/07/2020 |