Colby Bray Fagan, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN2325154 Issued in MA

Practice address

354 Tremont St
Boston, MA 02116-5538

Phone

(617) 426-9200

Fax

(617) 426-9201

NPI assigned

Oct 6, 2021

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Porter Pediatrics Comprehensive Pediatric Health Care.PC

  • Pediatrics Physician
  • Boston, MA
  • NPI 1760495105
  NPD (past)
• Pratt Pediatric Associates Inc

  • Pediatrics Physician
  • Boston, MA
  • NPI 1477590511
  NPD (past)

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1710649835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 TREMONT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165538",
            "telephone_number": "617-429-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 TREMONT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165538",
            "telephone_number": "617-426-9200",
            "fax_number": "617-426-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "COLBY",
        "middle_name": "BRAY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN2325154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Fadus
• Verena Faehling, M.D.
• Steven Faerstain, M.D.
• Craig Fafara
• Eleni Cassie Fafoutis
• Maura A Fagan, M.D.
• Maureen Bernadette Fagan, RNP/MS
• Siedah Fagan
• Stephanie Javier Fagbemi, MD
• Peter J Fagenholz, M.D.

• Pediatric Nurse Practitioner in Boston, MA
• Providers in Boston, MA by specialty
• Pediatric Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.