Provider Demographics
NPI:1669412722
Name:FAUTEUX, GREGORY MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MATTHEW
Last Name:FAUTEUX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 GREAT MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2355
Mailing Address - Country:US
Mailing Address - Phone:860-563-0700
Mailing Address - Fax:860-563-0741
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5266
Practice Address - Fax:860-826-4992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT042140207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I06450Medicare UPIN