MEDICARE: DR. MATTHEW J FAGAN MD

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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	MD429235	PA
2	207VG0400X	Gynecology Physician	MD429235	PA
3	207VG0400X	Gynecology Physician	C10011078	DE
4	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	C1-0011078	DE
5	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	MD429235	PA
6	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	C10011078	DE

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	:	1538184791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J FAGAN MD

Provider Business Mailing Address
First Line	:	200 HYGEIA DR
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4375 OGLETOWN STANTON ROAD
Second Line	:	SUITE 1208
City	:	NEWARK
State	:	DE
Zip	:	19713-2089
Country	:	US
Telephone Number	:	302-623-4055
Fax Number	:	302-623-4056

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/30/2017

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