Provider Demographics
NPI:1316901093
Name:LONG, THOMAS D JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:LONG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573
Mailing Address - Country:US
Mailing Address - Phone:336-598-6000
Mailing Address - Fax:336-598-6025
Practice Address - Street 1:783 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573
Practice Address - Country:US
Practice Address - Phone:336-598-6000
Practice Address - Fax:336-598-6025
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9700646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2243845Medicare ID - Type Unspecified
G57142Medicare UPIN