Provider Demographics
NPI:1609956770
Name:LONG, DAVID LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LYNN
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8614
Mailing Address - Fax:240-566-1600
Practice Address - Street 1:1330 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2915
Practice Address - Country:US
Practice Address - Phone:803-708-8126
Practice Address - Fax:803-708-1370
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14626207LC0200X, 207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC050028875OtherRR MEDICARE
SC146265Medicaid
SC4229859OtherAETNA
SC146265OtherSELECT HEALTH
SC2001249OtherCCP
SC77842OtherMEDCOST
SCF28443Medicare UPIN
SCF284431358Medicare ID - Type Unspecified