Provider Demographics
NPI:1467477232
Name:FAGIN, RONALD RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RICHARD
Last Name:FAGIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVENUE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404
Mailing Address - Country:US
Mailing Address - Phone:912-354-3954
Mailing Address - Fax:912-355-3711
Practice Address - Street 1:4750 WATERS AVENUE
Practice Address - Street 2:SUITE 311
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-354-3954
Practice Address - Fax:912-355-3711
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA14619207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D45305Medicare UPIN