Provider Demographics
NPI:1104893528
Name:LONG, LEANA S (MD)
Entity type:Individual
Prefix:
First Name:LEANA
Middle Name:S
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:SUITE 1300
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2505
Practice Address - Country:US
Practice Address - Phone:757-345-1001
Practice Address - Fax:757-345-3102
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101241855207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I12215Medicare UPIN
VAP00604202Medicare PIN
VA1081570041Medicare NSC
VA016644R53Medicare PIN
VA1104893528Medicaid