Individual
DAVID S FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 BOULDER POINT DR, SUITE 1, PLYMOUTH, NH 03264-3170
(603) 536-4000
(603) 536-4001
Mailing address
101 BOULDER POINT DR, SUITE 1, PLYMOUTH, NH 03264-3170
(603) 536-4000
(603) 536-4001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
NH8707
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110095743
RRMCR
—
01
—
11P018
MVP
VT
01
—
137310
CIGNA SCRANTON
PA
05
—
2165
—
VT
05
—
80002165
—
NH
01
—
ANTHEM
BLUE CROSS BLUE SHIELD
NH
01
—
FAGA18669
VT BC BS
VT
Enumeration date
07/03/2006
Last updated
03/26/2010
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