Provider Demographics
NPI:1346440237
Name:FAUSTIN, ALEX (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:FAUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BROAD ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4350
Mailing Address - Country:US
Mailing Address - Phone:203-634-0086
Mailing Address - Fax:203-237-6010
Practice Address - Street 1:816 BROAD ST
Practice Address - Street 2:SUITE 24
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4350
Practice Address - Country:US
Practice Address - Phone:203-634-0086
Practice Address - Fax:203-237-6010
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT049152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1346440237Medicaid
CTD400032860Medicare PIN