Provider Demographics
NPI:1114927043
Name:AGAPE FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:AGAPE FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-270-0335
Mailing Address - Street 1:410 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5351
Mailing Address - Country:US
Mailing Address - Phone:717-270-0335
Mailing Address - Fax:717-270-9740
Practice Address - Street 1:410 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5351
Practice Address - Country:US
Practice Address - Phone:717-270-0335
Practice Address - Fax:717-270-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-064156L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5130980OtherHEALTHGUARD
L019072OtherBLUE CROSS/BLUE SHIELD
PA01711849Medicaid
129891OtherHEALTH AMERICA/ASSURANCE
1684763OtherHIGHMARK BLUE SHIELD
85419OtherAETNA
01391101OtherCAPITAL BLUE CROSS
15097OtherGEISINGER HEALTH PLAN
L019072OtherBLUE CROSS/BLUE SHIELD
15097OtherGEISINGER HEALTH PLAN