Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD461270 | PA |
NPI | 1033525639 |
---|---|
Provider Name | Kyle Alexander Long |
First Address | Erie, PA 16550-0002 |
Second Address | Erie, PA 16550-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 04/10/2021 |