Provider Demographics
NPI:1154716678
Name:MCGANN, FAHMIDA KHAN (DO)
Entity type:Individual
Prefix:
First Name:FAHMIDA
Middle Name:KHAN
Last Name:MCGANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:FAHMIDA
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4755 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 2E70
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2220
Mailing Address - Country:US
Mailing Address - Phone:302-733-6338
Mailing Address - Fax:302-733-6386
Practice Address - Street 1:160 ROBBINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2652
Practice Address - Country:US
Practice Address - Phone:203-573-7284
Practice Address - Fax:203-573-7031
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65852207R00000X, 207RI0200X
DEC7-0005955207R00000X
PA30962849390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program