MEDICARE: DR. MARTHA E 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	207V00000X	Obstetrics & Gynecology Physician	01066632A	IN
2	207V00000X	Obstetrics & Gynecology Physician	0101233798	VA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831179373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA E FAGAN MD

Provider Business Mailing Address
First Line	:	1050 REID PARKWAY
Second Line	:	SUITE 220
City	:	RICHMOND
State	:	IN
Zip	:	47374-1156
Country	:	US
Telephone Number	:	765-962-9541
Fax Number	:	765-966-5952

Provider Business Practice Location Address
First Line	:	1050 REID PARKWAY
Second Line	:	SUITE 220
City	:	RICHMOND
State	:	IN
Zip	:	47374-1156
Country	:	US
Telephone Number	:	765-962-9541
Fax Number	:	765-966-5952

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	05/13/2021

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Directions to “ DR. MARTHA E FAGAN MD” Practice Location

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