Provider Demographics
NPI:1205860509
Name:LONG, MARTA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63524
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6116
Mailing Address - Country:US
Mailing Address - Phone:949-237-2949
Mailing Address - Fax:
Practice Address - Street 1:19712 MACARTHUR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2407
Practice Address - Country:US
Practice Address - Phone:949-237-2949
Practice Address - Fax:682-219-0893
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0101009207RG0300X, 207R00000X
VA0101244103207R00000X
CAA101009207R00000X
WA60489001207R00000X
CT044642208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist