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NPI Code Detail

MEDICARE: PATRICK FAGAN DO

MEDICARE: PATRICK FAGAN DO
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
1207L00000XAnesthesiology Physician0102205660VA

General Provider Information

NPI Number : 1457746802
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK FAGAN DO
Provider Business Mailing Address
First Line : 7550 S BLACKHAWK ST APT 4208
Second Line :
City : ENGLEWOOD
State : CO
Zip : 80112-4082
Country : US
Telephone Number : 224-406-3341
Fax Number :
Provider Business Practice Location Address
First Line : 7101 JAHNKE RD
Second Line :
City : RICHMOND
State : VA
Zip : 23225-4017
Country : US
Telephone Number : 804-483-0745
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2015
Last Update Date : 01/20/2026

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