Individual
THEODORE GEORGIAN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-2470
(203) 688-4516
Mailing address
333 CEDAR ST, P.O. BOX 208088, NEW HAVEN, CT 06510-3206
(203) 785-4148
(203) 785-3461
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
52498
CT
Other
Enumeration date
03/31/2010
Last updated
10/25/2013
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