Provider Demographics
NPI:1376772988
Name:FAGAN, MARGARET JOAN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:JOAN
Last Name:FAGAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MOHICAN ST
Mailing Address - Street 2:
Mailing Address - City:LESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19029-1621
Mailing Address - Country:US
Mailing Address - Phone:610-521-0740
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 3002
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-4973
Practice Address - Fax:610-237-7311
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001899D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1002660916001Medicaid