Provider Demographics
NPI:1689861635
Name:LONG, JAMES BLAKELEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BLAKELEY
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:7547 MEDICAL DR STE 2200
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4351
Practice Address - Country:US
Practice Address - Phone:804-693-2720
Practice Address - Fax:804-694-0597
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01198207R00000X
VA0101257744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2022311Medicare PIN
NC5909561Medicaid