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General NPI Number Information
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NPI Number | 1457746802
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Entity Type | Individual
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Provider Name | PATRICK FAGAN DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 7101 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4017
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Country | US
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Telephone | 804-483-0745
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Fax |
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Provider Business Mailing Address
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Address Line | 7550 S BLACKHAWK ST APT 4208
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City | ENGLEWOOD
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State | CO
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Zip | 80112-4082
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Country | US
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Telephone | 224-406-3341
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0102205660
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License Number State | VA
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