Provider Demographics
NPI:1841494515
Name:KAREN FAGIN MD LLC
Entity type:Organization
Organization Name:KAREN FAGIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-528-5930
Mailing Address - Street 1:PO BOX 4054
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-4054
Mailing Address - Country:US
Mailing Address - Phone:334-821-7511
Mailing Address - Fax:
Practice Address - Street 1:2000 PEPPERELL PKWY BLDG 190
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5452
Practice Address - Country:US
Practice Address - Phone:334-528-5930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27896207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG23164Medicare UPIN