Provider Demographics
NPI:1730145756
Name:LONG, D SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:D SCOTT
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DON
Other - Middle Name:SCOTT
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7000
Mailing Address - Fax:513-246-5627
Practice Address - Street 1:2001 ANDERSON FERRY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3325
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-5627
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-1814-L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2384772Medicaid
OH006175OtherBETHESDA HOSP PROVIDER
OHLO4137822Medicare PIN
OHDLG483Medicare ID - Type UnspecifiedPROVIDER NUMBER
OHH 79376Medicare UPIN
OHDL81814Medicare ID - Type UnspecifiedPROVIDER NUMBER