Provider Demographics
NPI:1811975964
Name:LONGTINE, JANINA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JANINA
Middle Name:ANN
Last Name:LONGTINE
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 1:310 CEDAR ST # LH315B
Mailing Address - Street 2:PO BOX 208023
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3218
Mailing Address - Country:US
Mailing Address - Phone:203-785-7193
Mailing Address - Fax:
Practice Address - Street 1:310 CEDAR ST # LH315B
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-785-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-07
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054996207SM0001X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
63557OtherFALLON COMMUNITY HEALTH
2929184OtherAETNA U,S. HEALTHCARE
MA3034259Medicaid
8794505OtherCIGNA
MA730611OtherTUFTS
MAA59244Medicare UPIN
MA341126OtherHPHC
MA341126OtherHPHC
220025435Medicare ID - Type UnspecifiedRR BINNEY MED