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General NPI Number Information
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NPI Number | 1831179373
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Entity Type | Individual
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Provider Name | MARTHA E FAGAN MD
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Gender | Female
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 1050 REID PARKWAY SUITE 220
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City | RICHMOND
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State | IN
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Zip | 47374-1156
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Country | US
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Telephone | 765-962-9541
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Fax | 765-966-5952
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Provider Business Mailing Address
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Address Line | 1050 REID PARKWAY SUITE 220
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City | RICHMOND
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State | IN
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Zip | 47374-1156
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Country | US
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Telephone | 765-962-9541
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Fax | 765-966-5952
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01066632A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101233798
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License Number State | VA
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