Active NPI
Fangnan Elisha Ndam, M.D.
- Anatomic Pathology Physician
- Fort Worth, TX
National Provider Identifier
1780145292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology Physician
- License
- 85218-20
- Practice address
- 200 Feliks Gwozdz PL
Fort Worth, TX 76104-4919 - Phone
- (817) 920-5700
- Fax
- (817) 920-5713
- NPI assigned
- Mar 27, 2019
- Reactivated
- May 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology Physician | 207ZP0101X | 85218-20 | WI | Primary |
Addresses
Primary practice location
200 Feliks Gwozdz PL
Fort Worth, TX 76104-4919
Mailing address
200 Feliks Gwozdz PL
Fort Worth, TX 76104-4919
Phone (817) 920-5700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85218-20 | WI | MD | Anatomic Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nizam Peerwani Mdpa | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Legal Medicine (M.D./D.O.) Physician
- Fort Worth, TX
- NPI 1316487838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748995200000",
"number": "1780145292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 FELIKS GWOZDZ PL",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044919",
"telephone_number": "817-920-5700",
"fax_number": "817-920-5713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 FELIKS GWOZDZ PL",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044919",
"telephone_number": "817-920-5700",
"fax_number": "817-920-5713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NDAM",
"first_name": "FANGNAN",
"middle_name": "ELISHA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-27",
"last_updated": "2025-06-04",
"certification_date": "2025-06-04",
"deactivation_date": "2019-11-04",
"reactivation_date": "2022-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "WI",
"license": "85218-20",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.