Provider Demographics
NPI:1093517849
Name:LONG, TREVOR (MA)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:LONG
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 HOLM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1207
Mailing Address - Country:US
Mailing Address - Phone:925-337-7630
Mailing Address - Fax:
Practice Address - Street 1:330CORBETT HALL
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469-0001
Practice Address - Country:US
Practice Address - Phone:207-581-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program