Provider Demographics
NPI:1982798849
Name:LONG, PAUL MCCRARY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MCCRARY
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6613
Mailing Address - Country:US
Mailing Address - Phone:843-681-5305
Mailing Address - Fax:843-689-5210
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6613
Practice Address - Country:US
Practice Address - Phone:843-681-5305
Practice Address - Fax:843-689-5210
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC8178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC081789Medicaid
SC081789Medicaid
SCD99416Medicare UPIN