Provider Demographics
NPI:1528144581
Name:DANG, LONG HOANG (MD, PHD)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:HOANG
Last Name:DANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-268-4200
Mailing Address - Fax:
Practice Address - Street 1:490 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2871
Practice Address - Country:US
Practice Address - Phone:321-268-4200
Practice Address - Fax:321-268-1386
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104267207RH0000X, 207RH0003X, 207RX0202X, 207RH0000X
MI4301081342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108472900Medicaid
FLM5451OtherMEDICARE HF
FL108472900Medicaid
FLCD195ZMedicare PIN
MIH89697Medicare UPIN
MI4523842Medicaid