Provider Demographics
NPI:1861471179
Name:LONGO, WILLIAM AMERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:AMERICO
Last Name:LONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2419
Mailing Address - Country:US
Mailing Address - Phone:860-346-2608
Mailing Address - Fax:
Practice Address - Street 1:520 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4700
Practice Address - Country:US
Practice Address - Phone:860-346-2608
Practice Address - Fax:860-347-4691
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023666208600000X, 2086S0129X, 2086X0206X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001236660Medicaid
CTB38365Medicare UPIN
CT001236660Medicaid