Provider Demographics
NPI:1861477069
Name:AL-KHAYER, FADI A (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:A
Last Name:AL-KHAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PROFFESSIONAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1659
Mailing Address - Country:US
Mailing Address - Phone:860-487-9102
Mailing Address - Fax:860-487-9912
Practice Address - Street 1:28 PROFFESSIONAL PARK RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-1659
Practice Address - Country:US
Practice Address - Phone:860-487-9102
Practice Address - Fax:860-487-9912
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039975207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00122064OtherRAILROAD MEDICARE
CT001399759Medicaid
CT110008917Medicare PIN
H88376Medicare UPIN