Basic Information
| Provider Information | |||||||||
| NPI: | 1457683385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | MILLY | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 EDGMONT AVE | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105956586 | ||||||||
| FaxNumber: | 6105956787 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 E CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190782212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105956586 | ||||||||
| FaxNumber: | 6105956787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD040300L | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.