Healthcare Provider Details

I. General information

NPI: 1861477069
Provider Name (Legal Business Name): FADI A AL-KHAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 PROFFESSIONAL PARK RD
STORRS CT
06268-1659
US

IV. Provider business mailing address

28 PROFFESSIONAL PARK RD
STORRS CT
06268-1659
US

V. Phone/Fax

Practice location:
  • Phone: 860-487-9102
  • Fax: 860-487-9912
Mailing address:
  • Phone: 860-487-9102
  • Fax: 860-487-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number039975
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: