Provider Demographics
NPI:1467454728
Name:GAUDIO, ALEXANDER RUDOLF (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:RUDOLF
Last Name:GAUDIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1043 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2110
Mailing Address - Country:US
Mailing Address - Phone:860-549-2020
Mailing Address - Fax:860-549-2025
Practice Address - Street 1:1043 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2110
Practice Address - Country:US
Practice Address - Phone:860-549-2020
Practice Address - Fax:860-549-2025
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011792207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004242492Medicaid
MA9736841Medicaid
CT004242492Medicaid
CTE74769Medicare UPIN