Walter J. Fagan, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

MD035284E Issued in PA

Practice address

211 Center Ave
Jim Thorpe, PA 18229-1205

Phone

(817) 845-1968

NPI assigned

Aug 1, 2013

Last updated

Aug 1, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375315200000",
    "number": "1659703635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 CENTER AVE",
            "city": "JIM THORPE",
            "state": "PA",
            "postal_code": "182291205",
            "telephone_number": "817-845-1968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CENTER AVE",
            "city": "JIM THORPE",
            "state": "PA",
            "postal_code": "182291205",
            "telephone_number": "817-845-1968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "WALTER",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-01",
        "last_updated": "2013-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "MD035284E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Leigh Dombrosky, PHRN
• Deborah Sue Dyer, LMT
• Laura Dyson, LMT
• Emilea Evans
• John Paul Evans III, P.T.
• John J Fallabel, DMD
• Jennifer Lynn Gaines, DPT
• Kimberly Gauronsky
• Daryl J Gordon, CRNP
• Marla G Grafton, LCSW

• Vascular Surgery Physician in Jim Thorpe, PA
• Providers in Jim Thorpe, PA by specialty
• Vascular Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.