DR. WALTER J. FAGAN (NPI# 1659703635) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659703635 |
| Entity Type | Individual |
| Full Name | DR. WALTER J. FAGAN |
| Credential | M.D. |
| Practice Address |
211 Center Ave Jim Thorpe PA 18229-1205 |
| Practice Telephone | 8178451968 |
| Mailing Telephone | 8178451968 |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2013-08-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
MD035284E | PA | Allopathic & Osteopathic Physicians |
| Street Address |
211 CENTER AVE |
| City | JIM THORPE |
| State | PA |
| Zip Code | 18229-1205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093083859 | Nancy M. Porambo | Massage Therapist | 616 Center Street, Jim Thorpe, PA 18229 | 2011-12-08 |
| 1407967987 | Carol Ann Kardisco | Social Worker | 27 W Sixth Street, Jim Thorpe, PA 18229 | 2006-08-31 |
| 1639199144 | Jim Thorpe Ems | Ambulance | 100 E 10th St, Jim Thorpe, PA 18229 | 2006-07-20 |
| 1871697573 | Jayendra C Patel | Dentist | 903 Center St, Jim Thorpe, PA 18229 | 2006-09-12 |
| 1568453652 | Nancy Leigh Dombrosky | Emergency Medical Technician, Paramedic | 1491 Center Ave, Jim Thorpe, PA 18229-1009 | 2005-10-29 |
| 1104802651 | Patrick J Hanley | Emergency Medicine | 1580 Center Ave, Jim Thorpe, PA 18229-1012 | 2005-12-16 |
| 1134240005 | Eileen P Connors | Nurse Practitioner | 1580 Center Ave, Jim Thorpe, PA 18229-1012 | 2007-04-02 |
| 1487773966 | Switchback Medical Center PC | Family Medicine | 1580 Center Ave, Jim Thorpe, PA 18229-1012 | 2007-03-28 |
| 1063554467 | Vanessa Rice | Family Medicine | 1580 Center Ave, Jim Thorpe, PA 18229-1012 | 2007-02-13 |
| 1154382604 | Deborah Ann Smith | Family Medicine | 1580 Center Ave, Jim Thorpe, PA 18229-1012 | 2006-03-31 |
| Find all providers in zip 18229 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720630650 | Broad Street Professional Medical Services LLC | Surgery | 2033 S Broad St Ste A, Philadelphia, PA 19148-5505 | 2019-07-11 |
| 1124670922 | Broad Street Medical LLC | Surgery | 2033 S Broad St Ste B, Philadelphia, PA 19148-5505 | 2019-07-11 |
| 1932610755 | Vascular Surgical Specialists Pllc | Surgery | 1450 E Boot Rd Ste 600b, West Chester, PA 19380-5968 | 2017-10-19 |
| 1336515956 | Aria Health Physician Services | Surgery | 9501 Roosevelt Blvd Ste 312, Philadelphia, PA 19114-1028 | 2015-08-18 |
| 1437525490 | Advanced Vein and Laser Center Lancaster, LLC | Surgery | 896a Plaza Blvd, Lancaster, PA 17601-2745 | 2015-08-13 |
| 1447658877 | Center for Vein Restoration Pa Pllc | Surgery | 1338 Bristol Pike Ste 205, Bensalem, PA 19020-5679 | 2014-12-17 |
| 1023423167 | Catherine Go | Surgery | 420 S Aiken Ave, Apt A6, Pittsburgh, PA 15232-1226 | 2014-06-27 |
| 1346521267 | Usa Vein Clinics of Philadelphia LLC | Surgery | 51 Cameron Rd, Huntingdon Valley, PA 19006-1401 | 2011-09-06 |
| 1124314893 | Nathan Loren Liang | Surgery | 200 Lothrop St # A-1017, Pittsburgh, PA 15213-2536 | 2011-06-21 |
| 1619266996 | Christopher Robert Simon Werter | Surgery | 1259 S Cedar Crest Blvd Ste 301, Allentown, PA 18103-6206 | 2011-04-07 |
| Find all providers with the same taxonomy | ||||
| City | JIM THORPE |
| Zip Code | 18229 |
Please comment or provide details below to improve the information on DR. WALTER J. FAGAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.