Roy O Fagan III MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

37825 Issued in NC

Legal business name

ROY O FAGAN III MD PA

Practice address

419 W Harrison St
Reidsville, NC 27320-5015

Phone

(336) 342-4448

Fax

(336) 342-4499

NPI assigned

Dec 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Roy O Fagan, MDNPI 1023075140

Title

President

Phone

(336) 342-4448

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roy O Fagan III, MD

  • Internal Medicine Physician
  • Reidsville, NC
  • NPI 1023075140
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1023291234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 W HARRISON ST",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273205015",
            "telephone_number": "336-342-4448",
            "fax_number": "336-342-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 W HARRISON ST",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273205015",
            "telephone_number": "336-342-4448",
            "fax_number": "336-342-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROY O FAGAN III MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-342-4448",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "37825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7931038",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rockingham Urology Associates
• Amy Beth Kapitany Rose, MA CCC-SLP
• Deborah Rosalie Ross, MD
• William Alexander Ross II, DMD
• Robert Michael Rourk, M.D.
• George Anthony Rucker
• Collin Wofford Runyon, PHARMD
• Cyththia Jane Russell, P.T.
• Ruths Cove
• Elizabeth Rutledge

• Internal Medicine Physician in Reidsville, NC
• Providers in Reidsville, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.