Provider Demographics
NPI:1396091286
Name:ALEXANDER J. FORTIER MDPC
Entity type:Organization
Organization Name:ALEXANDER J. FORTIER MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FORTIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-667-0207
Mailing Address - Street 1:505 WILLARD AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2650
Mailing Address - Country:US
Mailing Address - Phone:860-667-0207
Mailing Address - Fax:860-665-1133
Practice Address - Street 1:505 WILLARD AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2650
Practice Address - Country:US
Practice Address - Phone:860-667-0207
Practice Address - Fax:860-665-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18165207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001181650Medicaid
1346350501OtherDR. FORTIER'S NPI
1346350501OtherDR. FORTIER'S NPI
B84411Medicare UPIN