Provider Demographics
NPI:1073599387
Name:FAGAN, JAMES B (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:FAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:745 W STATE ST
Mailing Address - Street 2:STE 510
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1515
Mailing Address - Country:US
Mailing Address - Phone:614-464-0788
Mailing Address - Fax:614-464-0295
Practice Address - Street 1:745 W STATE ST
Practice Address - Street 2:STE 510
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1515
Practice Address - Country:US
Practice Address - Phone:614-464-0788
Practice Address - Fax:614-464-0295
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35056285207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0688528Medicaid
OH0688528Medicaid
OH0619167Medicare PIN