# ELLEN FAN M D P A

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467890178
- **Authorized official:** DR. ELLEN FAN M.D. (PHYSICIAN)
- **Authorized official phone:** (972) 769-8572

## Contact information

- **Practice address:** 8240 MANDERVILLE LN, DALLAS, TX 75231-1104
- **Practice address phone:** (972) 769-8572
- **Practice address fax:** (972) 769-8591
- **Mailing address:** 3308 PRESTON RD, SUITE 350 BOX 242, PLANO, TX 75093-7453
- **Mailing address phone:** (972) 769-8572
- **Mailing address fax:** (972) 769-8591

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0805X | Geriatric Psychiatry Physician | K8897 | TX | Yes |

## Other

- **Enumeration date:** 06/05/2013
- **Last updated:** 05/29/2025