Provider Demographics
NPI:1174586846
Name:LONG, STEPHEN N (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:N
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-1058
Mailing Address - Country:US
Mailing Address - Phone:336-598-6036
Mailing Address - Fax:336-598-6025
Practice Address - Street 1:783 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4575
Practice Address - Country:US
Practice Address - Phone:336-599-3212
Practice Address - Fax:336-598-6025
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952674Medicaid
C82283Medicare UPIN
NC8952674Medicaid