Provider Demographics
NPI:1720140460
Name:LONG, SHARON (CMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 WHITFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1809
Mailing Address - Country:US
Mailing Address - Phone:410-869-0908
Mailing Address - Fax:800-858-8130
Practice Address - Street 1:443 WHITFIELD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1809
Practice Address - Country:US
Practice Address - Phone:410-869-0908
Practice Address - Fax:800-858-8130
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist