MEDICARE: MARGARET JOAN FAGAN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	SP001899D	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376772988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET JOAN FAGAN CRNP

Provider Business Mailing Address
First Line	:	341 MOHICAN ST
Second Line	:
City	:	LESTER
State	:	PA
Zip	:	19029-1621
Country	:	US
Telephone Number	:	610-521-0740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 LANSDOWNE AVE
Second Line	:	SUITE 3002
City	:	DARBY
State	:	PA
Zip	:	19023-1330
Country	:	US
Telephone Number	:	610-237-4973
Fax Number	:	610-237-7311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	01/31/2012

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