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General NPI Number Information
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NPI Number | 1396091286
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Entity Type | Organization
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Legal Business Name | ALEXANDER J. FORTIER MDPC
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 505 WILLARD AVE SUITE 2B
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City | NEWINGTON
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State | CT
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Zip | 06111-2650
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Country | US
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Telephone | 860-667-0207
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Fax | 860-665-1133
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Provider Business Mailing Address
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Address Line | 505 WILLARD AVE SUITE 2B
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City | NEWINGTON
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State | CT
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Zip | 06111-2650
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Country | US
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Telephone | 860-667-0207
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Fax | 860-665-1133
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | DR. ALEXANDER JOSEPH FORTIER
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Credential | M.D.
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Telephone | 860-667-0207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 18165
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License Number State | CT
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