Provider Demographics
NPI:1619096948
Name:HAGE, FAOUZI (PA-C)
Entity Type:Individual
Prefix:
First Name:FAOUZI
Middle Name:
Last Name:HAGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1315
Mailing Address - Country:US
Mailing Address - Phone:860-514-7339
Mailing Address - Fax:860-535-3030
Practice Address - Street 1:75 SWANTOWN HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-1022
Practice Address - Country:US
Practice Address - Phone:860-445-3005
Practice Address - Fax:860-535-3401
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant