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General NPI Number Information
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NPI Number | 1679156384
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Entity Type | Individual
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Provider Name | CARLOS ALEXIS LLANES MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 1250 SILVER ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3946
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Country | US
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Telephone | 860-346-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 SILVER ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3946
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Country | US
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Telephone | 860-346-0300
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Fax | 617-730-0252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 1019289
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 081411
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License Number State | CT
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