Provider Demographics
NPI:1770927105
Name:LONG, DAVID HOLLIS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOLLIS
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:320 HOSPITAL DR
Mailing Address - Street 2:EMERGENCY MEDICINE DEPT
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24115-0000
Mailing Address - Country:US
Mailing Address - Phone:276-666-7600
Mailing Address - Fax:
Practice Address - Street 1:320 HOSPITAL DR
Practice Address - Street 2:EMERGENCY MEDICINE DEPT
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24115-0000
Practice Address - Country:US
Practice Address - Phone:276-666-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101259030207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services