Basic Information
| Provider Information | |||||||||
| NPI: | 1962579037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | STEWART | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1890 METRO CENTER DR | ||||||||
| Address2: | |||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037091500 | ||||||||
| FaxNumber: | 7037091697 | ||||||||
| Practice Location | |||||||||
| Address1: | 1890 METRO CENTER DR | ||||||||
| Address2: | |||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037091500 | ||||||||
| FaxNumber: | 7037091697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101056289 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.