Individual
SAMUEL SHAW FAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1415 OLD GULPH RD, VILLANOVA, PA 19085-2041
(610) 520-0246
(610) 525-3737
Mailing address
PO BOX 369, VILLANOVA, PA 19085-0369
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
028579
CT
208000000X
Pediatrics Physician
G37093
CA
Other
Enumeration date
05/31/2017
Last updated
05/31/2017
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