Provider Demographics
NPI:1902802804
Name:FURLONG, JUDITH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:FURLONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 HARROUN RD
Mailing Address - Street 2:#304
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2182
Mailing Address - Country:US
Mailing Address - Phone:419-824-1100
Mailing Address - Fax:419-824-1778
Practice Address - Street 1:5300 HARROUN RD
Practice Address - Street 2:#304
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2182
Practice Address - Country:US
Practice Address - Phone:419-824-1100
Practice Address - Fax:419-824-1778
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4114959Medicaid
OH0659747Medicaid
OHH178720Medicare PIN
OHA16609Medicare UPIN
OH80096789Medicare PIN
MI4114959Medicaid