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General NPI Number Information
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NPI Number | 1053344713
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Entity Type | Individual
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Provider Name | DANIEL FAGNANT DO
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Gender | Male
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 326 WASHINGTON ST
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City | NORWICH
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State | CT
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Zip | 06360-2740
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Country | US
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Telephone | 860-889-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 54 ANDERSON RD
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City | POMFRET CENTER
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State | CT
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Zip | 06259-2229
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Country | US
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Telephone | 860-963-0398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 000368
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License Number State | CT
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