Healthcare Provider Details

I. General information

NPI: 1790671485
Provider Name (Legal Business Name): ANNA FAGAN CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ORCHARD ST STE 107
NEW HAVEN CT
06511-4430
US

IV. Provider business mailing address

330 ORCHARD ST STE 107
NEW HAVEN CT
06511-4430
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-4362
  • Fax: 203-200-1362
Mailing address:
  • Phone: 203-200-4362
  • Fax: 203-200-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: