Healthcare Provider Details

I. General information

NPI: 1336142751
Provider Name (Legal Business Name): NANCY FAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/17/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 GREENHILL AVE
WILMINGTON DE
19805-1851
US

IV. Provider business mailing address

PO BOX 824804
PHILADELPHIA PA
19182-4804
US

V. Phone/Fax

Practice location:
  • Phone: 302-778-2229
  • Fax: 302-504-5010
Mailing address:
  • Phone: 302-575-8226
  • Fax: 302-575-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0005037
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: