Individual provider Active NPI

Mario Fahed, M.D.

  • Psychiatry Physician
  • Farmington, CT
National Provider Identifier
1548679525
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
060187 Issued in CT
Practice address
10 Talcott Notch
Farmington, CT 06032
Phone
(860) 679-6700
Fax
(860) 679-6736
NPI assigned
Aug 4, 2014
Last updated
Jun 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 060187 CT Primary

Addresses

Primary practice location

10 Talcott Notch
Farmington, CT 06032

Mailing address

263 Farmington Avenue
Farmington, CT 06030-8082
Phone (860) 679-6700

Other practice location 1

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-3165

Other practice location 2

950 Campbell Ave
West Haven, CT 06516-2770
Phone (203) 932-5711

Other practice location 3

950 Campbell Ave
West Haven, CT 06516-2770
Phone (203) 932-5711

Other practice location 4

263 Farmington Avenue
Farmington, CT 06030-8082
Phone (860) 679-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190626002479 CT Practitioner - Psychiatry 1456685338 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
060187CTMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Connecticut Health Center CurrentSince Jul 1, 2019 Accepting new patients
State of Connecticut CurrentSince Jul 1, 2019 Accepting new patients
State of Connecticut CurrentSince Jul 1, 2019 Accepting new patients
University of Connecticut Health Center CurrentSince Jul 1, 2019 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

10 Talcott Notch Rd
Farmington, CT 06032
Phone (860) 679-6700

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

Interoperability endpoints

  • Direct secure messaging: mfahed33635@direct.med.uchc.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1548679525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVENUE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060308082",
            "telephone_number": "860-679-6700",
            "fax_number": "860-679-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 TALCOTT NOTCH",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "06032",
            "telephone_number": "860-679-6700",
            "fax_number": "860-679-6736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 E Adams St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132102306",
            "country_code": "US",
            "telephone_number": "315-464-3165",
            "fax_number": "315-464-3178",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 Campbell Ave",
            "address_purpose": "LOCATION",
            "city": "West Haven",
            "state": "CT",
            "postal_code": "065162770",
            "country_code": "US",
            "telephone_number": "203-932-5711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 Campbell Ave",
            "address_purpose": "LOCATION",
            "city": "West Haven",
            "state": "CT",
            "postal_code": "065162770",
            "country_code": "US",
            "telephone_number": "203-932-5711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "263 Farmington Avenue",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "CT",
            "postal_code": "060308082",
            "country_code": "US",
            "telephone_number": "860-679-6700",
            "fax_number": "860-679-6736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAHED",
        "first_name": "MARIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-04",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "060187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.