Provider Demographics
NPI:1013980671
Name:LONG, SHERRI A (MD)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 VILLAGE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7848
Mailing Address - Country:US
Mailing Address - Phone:651-789-9800
Mailing Address - Fax:651-789-9810
Practice Address - Street 1:400 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7848
Practice Address - Country:US
Practice Address - Phone:651-789-9800
Practice Address - Fax:651-789-9810
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31866207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN974790700Medicaid
MN974790700Medicaid
MN070000439Medicare ID - Type Unspecified