Healthcare Provider Details

I. General information

NPI: 1487760351
Provider Name (Legal Business Name): IAIN FAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 EASTON RD
HELLERTOWN PA
18055-3312
US

IV. Provider business mailing address

2620 EASTON RD
HELLERTOWN PA
18055-3312
US

V. Phone/Fax

Practice location:
  • Phone: 570-357-6163
  • Fax:
Mailing address:
  • Phone: 570-357-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number202243
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20224301
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS009864L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: