Provider Demographics
NPI:1841302353
Name:DELONG, JOHN SCOTT (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:DELONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1841
Mailing Address - Country:US
Mailing Address - Phone:220-564-4677
Mailing Address - Fax:220-564-4678
Practice Address - Street 1:15 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1841
Practice Address - Country:US
Practice Address - Phone:220-564-4677
Practice Address - Fax:220-564-4678
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005988D207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0983888Medicaid
OHDE0821431Medicare ID - Type Unspecified
OH0983888Medicaid