Provider Demographics
NPI:1396860136
Name:LONG, NATHANIEL K (DO)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:K
Last Name:LONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4601
Mailing Address - Country:US
Mailing Address - Phone:614-788-5000
Mailing Address - Fax:614-788-5100
Practice Address - Street 1:303 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4601
Practice Address - Country:US
Practice Address - Phone:614-788-5000
Practice Address - Fax:614-788-5100
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35008962207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2742465Medicaid
4207762Medicare PIN