Provider Demographics
NPI:1841200466
Name:LONG, LANA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:L
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 1:1 WEST 4TH STREET
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202
Mailing Address - Country:US
Mailing Address - Phone:513-421-3376
Mailing Address - Fax:513-618-2128
Practice Address - Street 1:1 WEST 4TH STREET
Practice Address - Street 2:SUITE 2200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202
Practice Address - Country:US
Practice Address - Phone:513-421-3376
Practice Address - Fax:513-618-2128
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068727207N00000X
KY31630207N00000X
OH35.068727207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64316300Medicaid
F96275Medicare UPIN
KY1164302Medicare ID - Type Unspecified
KY64316300Medicaid
OHL04289401Medicare UPIN