Samuel Shaw Fager, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

028579 Issued in CT

Practice address

1415 Old Gulph Rd
Villanova, PA 19085-2041

Phone

(610) 520-0246

Fax

(610) 525-3737

NPI assigned

May 31, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496188800000",
    "number": "1780112078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "VILLANOVA",
            "state": "PA",
            "postal_code": "190850369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 OLD GULPH RD",
            "city": "VILLANOVA",
            "state": "PA",
            "postal_code": "190852041",
            "telephone_number": "610-520-0246",
            "fax_number": "610-525-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGER",
        "first_name": "SAMUEL",
        "middle_name": "SHAW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-31",
        "last_updated": "2017-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "028579",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G37093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Pinky Duggal, LAPC, ATR-P
• Adam David Edwards, A.T.C.
• Robert Esgro, R.PH., ESQ.
• Bijan Etemad, M.D.
• Gity Banan Etemad, M.D.
• Allison S. Fanelli, DO
• George Jay Feldman
• Molly Fenimore
• Marlee Finkelstein, M.ED, MS, RD, LDN
• Lisa Beth Freedman, M.D.

• Pediatrics Physician in Villanova, PA
• Providers in Villanova, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; 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.