Healthcare Provider Details

I. General information

NPI: 1053344713
Provider Name (Legal Business Name): DANIEL FAGNANT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

IV. Provider business mailing address

54 ANDERSON RD
POMFRET CENTER CT
06259-2229
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-8331
  • Fax:
Mailing address:
  • Phone: 860-963-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number000368
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: