Individual
DR. STANLEY A FAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
6123 MONTROSE RD, ROCKVILLE, MD 20852
(601) 881-3700
(301) 468-1862
Mailing address
6123 MONTROSE RD, ROCKVILLE, MD 20852
(601) 881-3700
(301) 468-1862
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
372
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206604
MHN
MD
01
—
236598
KAISER
MD
01
—
485491000
MAGALLAN
MD
01
—
530196598
TRICARE
MD
01
—
63558001
BCBS OF MD
MD
05
—
699555100
—
MD
01
—
7554447
AETNA
MD
01
—
A2840074
BCBS OF DC
DC
Enumeration date
08/16/2006
Last updated
07/08/2007
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