Individual provider Active NPI

Walter E Longo, MD

  • Colon & Rectal Surgery Physician
  • New Haven, CT
National Provider Identifier
1831160936
Registry record updated Mar 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
028590 Issued in CT
Practice address
800 Howard Ave
Ypb - Third Floor
New Haven, CT 06519-1369
Phone
(203) 785-4079
Fax
(203) 737-4033
NPI assigned
Jan 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery Physician 208C00000X 028590 CT Primary

Addresses

Primary practice location

800 Howard Ave
Ypb - Third Floor
New Haven, CT 06519-1369

Mailing address

800 Howard Ave
Ypb - Third Floor
New Haven, CT 06519-1369
Phone (203) 785-4079

Other identifiers 1

IdentifierTypeStateIssuer
001285908MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100610000358 CT Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 2062542509 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
028590CTMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Feb 14, 2003 Accepting new patients
Yale University CurrentSince Feb 14, 2003 Accepting new patients

Locations

50 Division St
Fl 6
New Haven, CT 06511

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

800 Howard Ave
Fl Third
New Haven, CT 06519
Phone (203) 785-4079

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299801600000",
    "number": "1831160936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 HOWARD AVE",
            "address_2": "YPB - THIRD FLOOR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191369",
            "telephone_number": "203-785-4079",
            "fax_number": "203-737-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 HOWARD AVE",
            "address_2": "YPB - THIRD FLOOR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191369",
            "telephone_number": "203-785-4079",
            "fax_number": "203-737-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGO",
        "first_name": "WALTER",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-28",
        "last_updated": "2011-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "CT",
            "license": "028590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001285908",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.