Provider Demographics
NPI:1942596168
Name:LONG, MEREDITH BLAIRE (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:BLAIRE
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 N MICHIGAN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:844-559-1600
Mailing Address - Fax:224-236-4900
Practice Address - Street 1:290 S MONACO PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1105
Practice Address - Country:US
Practice Address - Phone:303-355-2525
Practice Address - Fax:252-744-3924
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2019-05-22
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Provider Licenses
StateLicense IDTaxonomies
CODR.0056210208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program