Provider Demographics
NPI:1811643554
Name:LONG, CONNOR (PA-C)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:100 CALUMET ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3651
Mailing Address - Country:US
Mailing Address - Phone:402-580-8970
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2455
Practice Address - Country:US
Practice Address - Phone:781-624-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant