Provider Demographics
NPI:1568870012
Name:LONG, JEREMY (BOCPD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:BOCPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 ALBION AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2526
Mailing Address - Country:US
Mailing Address - Phone:828-246-5040
Mailing Address - Fax:
Practice Address - Street 1:2503 ALBION AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2526
Practice Address - Country:US
Practice Address - Phone:828-246-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist