Mark J Fagan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD05975 Issued in RI

Practice address

593 Eddy St
Apc 5
Providence, RI 02903-4923

Phone

(401) 444-4741

Fax

(401) 444-4445

NPI assigned

Jun 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1962449686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 VIRGINIA AVE",
            "address_2": "SUITE 107",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054406",
            "telephone_number": "401-443-4992",
            "fax_number": "401-784-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "APC 5",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-4741",
            "fax_number": "401-444-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD05975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9006702",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Fabricant, PHD
• Tootles Faccenda
• Paul D. Fadale, M.D.
• Christa N Fadden, OTR
• Misty April Faella, MA
• Cynthia Ann Fahey, PAC
• Sydney Elizabeth Fahey, MA
• Faith Fahnbulleh
• Momoh Bai Fahnbulleh
• Kiley Elizabeth Fair, AGACNP

• Internal Medicine Physician in Providence, RI
• Providers in Providence, RI by specialty
• Internal Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.