Basic Information
Provider Information
NPI: 1962482992
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LONG
FirstName: GEORGANNE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 PARKWEST CIR
Address2: SUITE 202
City: MIDLOTHIAN
State: VA
PostalCode: 231145551
CountryCode: US
TelephoneNumber: 8043202483
FaxNumber: 8047940050
Practice Location
Address1: 1401 JOHNSTON WILLIS DR
Address2: SUITE 5000
City: RICHMOND
State: VA
PostalCode: 232354730
CountryCode: US
TelephoneNumber: 8043202483
FaxNumber: 8047940050
Other Information
ProviderEnumerationDate: 01/17/2006
LastUpdateDate: 02/15/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VG0400X0101042241VAY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology

ID Information
IDTypeStateIssuerDescription
264063101 CIGNAOTHER
5181201 SENTARAOTHER
9453701 SOUTHERN HEALTHOTHER
32807801 MAMSIOTHER
000008341900201 UNITEDOTHER
086224801 AETNAUSHEALTHOTHER
54194104400201 TRICAREOTHER
22611701 ANTHEMOTHER
5181201 OPTIMA HEALTHOTHER
1194101 CARENETOTHER
1024069701 VA PREMIEROTHER


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