Provider Demographics
NPI:1891790846
Name:LONG, DENNIS SAGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:SAGE
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:488 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4615
Mailing Address - Country:US
Mailing Address - Phone:860-444-2416
Mailing Address - Fax:860-444-0250
Practice Address - Street 1:488 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4615
Practice Address - Country:US
Practice Address - Phone:860-444-2416
Practice Address - Fax:860-444-0250
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0167342080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061734OtherCONNECTICARE
CT010016734CT03OtherBLUE CROSS