Provider Demographics
NPI:1760482657
Name:LONG, REBECCA RICH (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RICH
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 10TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1607
Mailing Address - Country:US
Mailing Address - Phone:410-912-6167
Mailing Address - Fax:410-912-6168
Practice Address - Street 1:8700 GEORGIA AVE STE 400
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3605
Practice Address - Country:US
Practice Address - Phone:301-585-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064156L207Q00000X
MDD0090776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01711849Medicaid
PA089785YEBKMedicare PIN
PA089785YUNMMedicare PIN
85419OtherAETNA
1684763OtherHIGHMARK BLUE SHIELD
G87366Medicare UPIN
15097OtherGEISINGER HEALTH PLAN
5130980OtherHEALTH GUARD
L019072OtherBLUE CROSS/BLUE SHIELD
PA089785Medicare PIN