Provider Demographics
NPI:1962660696
Name:MIAO, CHUAN LONG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUAN
Middle Name:LONG
Last Name:MIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-332-5168
Mailing Address - Fax:540-332-5875
Practice Address - Street 1:70 MEDICAL CENTER CIR STE 302
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-245-7350
Practice Address - Fax:540-245-7359
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260781207RG0100X
PAMT 188868282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962660696Medicaid
VAP01775848Medicare PIN
VA1962660696Medicaid