Individual
MARY FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1055 ANDREW DR STE B, WEST CHESTER, PA 19380-3446
(610) 436-4448
Mailing address
306 SHROPSHIRE DR, WEST CHESTER, PA 19382-2216
(610) 653-2645
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
SPO27461
PA
363LP2300X
Primary Care Nurse Practitioner
Primary
SPO27461
PA
Other
Enumeration date
05/22/2023
Last updated
09/01/2023
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