Basic Information
| Provider Information | |||||||||
| NPI: | 1801844675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANAO | ||||||||
| FirstName: | FAUSTO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 SCOVILL ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037098873 | ||||||||
| FaxNumber: | 2037098689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 W MAIN ST | ||||||||
| Address2: | BUILDING 1, UNIT 1 | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067083119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037543151 | ||||||||
| FaxNumber: | 2035967287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 039801 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001398016 | 05 | CT | MEDICAID |