Provider Demographics
NPI:1346229002
Name:LONG, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LONG
Suffix:
Gender:M
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 249
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-0249
Mailing Address - Country:US
Mailing Address - Phone:828-465-9730
Mailing Address - Fax:828-465-9293
Practice Address - Street 1:305 1ST ST E
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-1715
Practice Address - Country:US
Practice Address - Phone:828-464-3821
Practice Address - Fax:828-464-8994
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18019173000000X
NC7218019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCN8132OtherMEDICARE RAILROAD
NC8952800Medicaid
NCAL5520235OtherDEA
C88972Medicare UPIN
NCAL5520235OtherDEA