Active NPI
John Long, MD
- Diagnostic Radiology Physician
- Bangor, ME
National Provider Identifier
1750465217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 008259
- Practice address
- 489 State St
Bangor, ME 04401-6616 - Phone
- (207) 973-8305
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 008259 | ME | |
| Neuroradiology Physician | 2085N0700X | 008259 | ME | |
| Diagnostic Radiology Physician | 2085R0202X | 008259 | ME | Primary |
| Therapeutic Radiology Physician | 2085R0203X | 008259 | ME | |
| Vascular & Interventional Radiology Physician | 2085R0204X | 008259 | ME | |
| Diagnostic Ultrasound Physician | 2085U0001X | 008259 | ME |
Addresses
Primary practice location
489 State St
Bangor, ME 04401-6616
Mailing address
300 Professional Dr
Scarborough, ME 04074-8433
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M80673 | Other | ME | CIGNA |
| C66140 | Other | ME | HPHC |
| 024275 | Other | ME | ANTHEM |
| 2323437 | Other | ME | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008259 | ME | MD | Diagnostic Ultrasound Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184457600000",
"number": "1750465217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 PROFESSIONAL DR",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040748433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "489 STATE ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016616",
"telephone_number": "207-973-8305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "JOHN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "ME",
"license": "008259",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "ME",
"license": "008259",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "ME",
"license": "008259",
"primary": true
},
{
"code": "2085R0203X",
"taxonomy_group": "",
"desc": "Radiology, Therapeutic Radiology",
"state": "ME",
"license": "008259",
"primary": false
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "ME",
"license": "008259",
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "ME",
"license": "008259",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "M80673",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPHC",
"identifier": "C66140",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "024275",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2323437",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.