Provider Demographics
NPI:1023054277
Name:LONG, WEBB E (MD)
Entity type:Individual
Prefix:
First Name:WEBB
Middle Name:E
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2957
Mailing Address - Country:US
Mailing Address - Phone:207-874-2141
Mailing Address - Fax:207-828-7850
Practice Address - Street 1:180 PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2927
Practice Address - Country:US
Practice Address - Phone:207-874-2141
Practice Address - Fax:207-874-2164
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21677208000000X
WI51162208000000X
MA243042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001628101Medicare PIN