Provider Demographics
NPI:1073604849
Name:LONG, HORACE ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:HORACE
Middle Name:ROBERT
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 53127
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-3127
Mailing Address - Country:US
Mailing Address - Phone:910-484-3121
Mailing Address - Fax:910-484-9027
Practice Address - Street 1:1606 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-4738
Practice Address - Country:US
Practice Address - Phone:910-484-3121
Practice Address - Fax:910-484-9027
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33544208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1521352OtherCIGNA HEALTHCARE
NC8952549Medicaid
NC52549OtherBLUE CROSS BLUE SHIELD
NCF52905Medicare UPIN