Provider Demographics
NPI:1518107747
Name:LONG, CHRISTINA S (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:S
Last Name:LONG
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:WAKE FOREST BAPTIST HEALTH
Mailing Address - Street 2:MEDICAL CENTER BLVD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-0572
Mailing Address - Fax:336-716-8018
Practice Address - Street 1:131 MILLER ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2508
Practice Address - Country:US
Practice Address - Phone:336-716-0572
Practice Address - Fax:336-716-8018
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2013-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC571213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917629Medicaid
NC5917629Medicaid