Basic Information
| Provider Information | |||||||||
| NPI: | 1790076347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | M.D./PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5220 GREENS DAIRY RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276164612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192563576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 BLUE RIDGE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276128087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197811437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2011 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 2015-02078 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.