Healthcare Provider Details

I. General information

NPI: 1205453719
Provider Name (Legal Business Name): DELANEY FAGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

1511 GILPIN AVE
WILMINGTON DE
19806-3015
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-1929
  • Fax:
Mailing address:
  • Phone: 484-354-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC5-0011533
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: