MEDICARE: KATIE FAGO

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	363A00000X	Physician Assistant	0110011639	VA

General Provider Information

NPI Number	:	1982562526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE FAGO

Provider Business Mailing Address
First Line	:	13 BROOKTREE RD
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-1817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8081 INNOVATION PARK DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4867
Country	:	US
Telephone Number	:	571-472-4724
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	02/16/2026

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Directions to “ KATIE FAGO ” Practice Location

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