Individual
STEPHANIE J. FANGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 N MARR RD, COLUMBUS, IN 47201-5505
(812) 376-9219
(812) 378-4821
Mailing address
1120 N. MARR ROAD, COLUMBUS, IN 47201-5501
(812) 376-9219
(812) 378-4821
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1030306
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000984524
ANTHEM PIN
—
05
—
100358650
—
IN
Enumeration date
06/29/2006
Last updated
04/22/2016
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