Provider Demographics
NPI:1306952049
Name:FAST, ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:FAST
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 1:620 10TH ST
Mailing Address - Street 2:SUITE 707
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1841
Mailing Address - Country:US
Mailing Address - Phone:716-282-5388
Mailing Address - Fax:716-282-5353
Practice Address - Street 1:620 10TH ST
Practice Address - Street 2:SUITE 707
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1841
Practice Address - Country:US
Practice Address - Phone:716-282-5388
Practice Address - Fax:716-282-5353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122023208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00050713003OtherBLUE CROSS/BLUE SHIELD
NY00632068Medicaid
NY00010053601OtherUNIVERA
NY1890012OtherINDEPENDENT HEALTH
NY00632068Medicaid
NY00050713003OtherBLUE CROSS/BLUE SHIELD