Provider Demographics
NPI:1952312225
Name:LONG, JUDITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:423 GUARDIAN DRIVE
Mailing Address - Street 2:1201 BLOCKLEY HALL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6021
Mailing Address - Country:US
Mailing Address - Phone:215-898-4311
Mailing Address - Fax:215-573-8778
Practice Address - Street 1:423 GUARDIAN DRIVE
Practice Address - Street 2:1201 BLOCKLEY HALL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6021
Practice Address - Country:US
Practice Address - Phone:215-898-4311
Practice Address - Fax:215-573-8778
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-10-20
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Provider Licenses
StateLicense IDTaxonomies
PAMD-060790-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine