Provider Demographics
NPI:1629336276
Name:LONG, BRIAN PANDIT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PANDIT
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 1:6303 LITTLE RIVER TPKE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5045
Mailing Address - Country:US
Mailing Address - Phone:703-914-8989
Mailing Address - Fax:703-914-5494
Practice Address - Street 1:6303 LITTLE RIVER TPKE STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312
Practice Address - Country:US
Practice Address - Phone:703-914-8989
Practice Address - Fax:703-914-5494
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101258313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program