Provider Demographics
NPI:1477659506
Name:LONG, SCOTT DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DAVID
Last Name:LONG
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:843-332-7419
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:1309 LEES CHAPEL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2601
Practice Address - Country:US
Practice Address - Phone:336-800-8958
Practice Address - Fax:336-286-5583
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-11-07
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Provider Licenses
StateLicense IDTaxonomies
NC103319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant