Provider Demographics
NPI:1467440198
Name:LONG, BARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
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 1:4601 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4522
Mailing Address - Country:US
Mailing Address - Phone:812-232-6673
Mailing Address - Fax:812-232-1519
Practice Address - Street 1:4601 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4522
Practice Address - Country:US
Practice Address - Phone:812-232-6673
Practice Address - Fax:812-232-1519
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038417A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C93169Medicare UPIN
IN607120BMedicare PIN