Healthcare Provider Details

I. General information

NPI: 1053401737
Provider Name (Legal Business Name): KAREN A. FAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3540
  • Fax: 202-741-2238
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number33695
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number28767
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: