Healthcare Provider Details

I. General information

NPI: 1568566214
Provider Name (Legal Business Name): ALEX BRIAN GOLDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST CONNECTICUT CHILDREN'S MED. CENTER, PED. CARDIOLOGY
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST CONNECTICUT CHILDREN'S MED. CENTER, PED. CARDIOLOGY
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9400
  • Fax:
Mailing address:
  • Phone: 860-545-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number54938
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: