Provider Demographics
NPI:1831131523
Name:FASANO, ALESSIO (MD)
Entity Type:Individual
Prefix:
First Name:ALESSIO
Middle Name:
Last Name:FASANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:175 CAMBRIDGE STREET CPZS-574
Mailing Address - Street 2:PEDIATRIC GASTROENTEROLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-1450
Mailing Address - Fax:617-724-2710
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:YAWKEY 6B-6800
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-8476
Practice Address - Fax:617-643-2384
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2013-02-27
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Provider Licenses
StateLicense IDTaxonomies
MDD466612080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203721100Medicaid
F80259Medicare UPIN
MDS818Medicare PIN