Provider Demographics
NPI:1952386195
Name:LONG, JAIME B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:B
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:35 HOPE DRIVE
Practice Address - Street 2:SUITES 202/204
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2036
Practice Address - Country:US
Practice Address - Phone:717-531-3503
Practice Address - Fax:717-531-4375
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433918207V00000X, 207VF0040X
AZ34110207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86080015085259C450OtherTRIWEST
PA127992OtherMEDICARE
AZP00272876OtherRAILROAD MEDICARE
PA010213023Medicaid
PAP00670380OtherRAILROAD MEDICARE - READING PROFESSIONAL SERVICES
AZ939754Medicaid
AZ939754Medicaid
PA127992OtherMEDICARE