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1962449686
MARK J FAGAN
PROVIDENCE, RI
NPI
1962449686
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: RI MD05975)
Enumeration Date
2006-06-01
Last Update Date
2016-09-02
Business Address
-- MARK J FAGAN MD
593 EDDY ST APC 5
PROVIDENCE, RI 02903-4923
Phone number: 401-444-4741
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Mailing Address
-- MARK J FAGAN MD
17 VIRGINIA AVE SUITE 107
PROVIDENCE, RI 02905-4406
Phone number: 401-443-4992
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