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General NPI Number Information
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NPI Number | 1467890178
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Entity Type | Organization
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Legal Business Name | ELLEN FAN M D P A
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 8240 MANDERVILLE LN
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City | DALLAS
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State | TX
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Zip | 75231-1104
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Country | US
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Telephone | 972-769-8572
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Fax | 972-769-8591
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Provider Business Mailing Address
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Address Line | 3308 PRESTON RD SUITE 350 BOX 242
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City | PLANO
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State | TX
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Zip | 75093-7453
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Country | US
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Telephone | 972-769-8572
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Fax | 972-769-8591
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ELLEN FAN
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Credential | M.D.
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Telephone | 972-769-8572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | K8897
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License Number State | TX
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