Provider Demographics
NPI:1801844675
Name:LANAO, FAUSTO (MD)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:
Last Name:LANAO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:133 SCOVILL ST
Mailing Address - Street 2:STE 101
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1127
Mailing Address - Country:US
Mailing Address - Phone:203-709-8873
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:BUILDING 1, UNIT 1
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-754-3151
Practice Address - Fax:203-596-7287
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2020-07-15
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Provider Licenses
StateLicense IDTaxonomies
CT039801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001398016Medicaid