Provider Demographics
NPI:1346350501
Name:FORTIER, ALEXANDER JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:FORTIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WILLARD AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2630
Mailing Address - Country:US
Mailing Address - Phone:860-667-0207
Mailing Address - Fax:860-665-1133
Practice Address - Street 1:505 WILLARD AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2630
Practice Address - Country:US
Practice Address - Phone:860-667-0207
Practice Address - Fax:860-667-0207
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018165207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AF7150129OtherDEA
AF7150129OtherDEA