Healthcare Provider Details

I. General information

NPI: 1457746802
Provider Name (Legal Business Name): PATRICK FAGAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

7550 S BLACKHAWK ST APT 4208
ENGLEWOOD CO
80112-4082
US

V. Phone/Fax

Practice location:
  • Phone: 804-483-0745
  • Fax:
Mailing address:
  • Phone: 224-406-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0102205660
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: