Provider Demographics
NPI:1033195482
Name:FANG, DEBORAH X (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:X
Last Name:FANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST
Mailing Address - Street 2:RADIATION ONCOLOGY DEPT.
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4201
Mailing Address - Country:US
Mailing Address - Phone:203-576-5085
Mailing Address - Fax:203-576-5445
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:RADIATION ONCOLOGY DEPT.
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4201
Practice Address - Country:US
Practice Address - Phone:203-576-5085
Practice Address - Fax:203-576-5445
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0408242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H42907Medicare UPIN