Individual
DR. MATTHEW J FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4375 OGLETOWN STANTON ROAD, SUITE 1208, NEWARK, DE 19713-2089
(302) 623-4055
(302) 623-4056
Mailing address
200 HYGEIA DR, NEWARK, DE 19713-2049
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
C10011078
DE
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
MD429235
PA
207VG0400X
Gynecology Physician
C10011078
DE
207VG0400X
Gynecology Physician
MD429235
PA
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
C1-0011078
DE
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
MD429235
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016687780001
—
PA
Enumeration date
07/12/2006
Last updated
05/30/2017
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