Provider Demographics
NPI:1144287913
Name:ISGUT, ALEJANDRO EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:EDUARDO
Last Name:ISGUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXANDER
Other - Middle Name:E
Other - Last Name:ISGUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:153 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2791
Mailing Address - Country:US
Mailing Address - Phone:203-270-1077
Mailing Address - Fax:203-426-2175
Practice Address - Street 1:153 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2791
Practice Address - Country:US
Practice Address - Phone:203-270-1077
Practice Address - Fax:203-426-2175
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016010207Q00000X, 208D00000X
CT16010208000000X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT016010OtherMEDICAL LICENSE
C59710Medicare UPIN
080000822Medicare ID - Type Unspecified
CT016010OtherMEDICAL LICENSE