Look up the most recent NPI and PECOS records

Theodore Georgian Long

Internal Medicine

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as THEODORE LONG.

Based on the most recent information from CMS, provider Theodore Georgian Long is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:14 PM.

Profile Details

Provider ID
1265757454
Provider Type
Individual
Full Name
Long, Theodore Georgian
Credential
M.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
3/31/2010
Last Updated
10/25/2013

Contact Information

Practice Location

20 York St, New Haven, CT 06510-3220

(203) 688-2470

(203) 688-4516

Mailing Location

333 Cedar St, P.O. Box 208088, New Haven, CT 06510-3206

(203) 785-4148

(203) 785-3461

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 52498 Connecticut

Theodore Georgian Long

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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