Provider Demographics
NPI:1194995837
Name:FAGIN, ALICE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MARIE
Last Name:FAGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:MARIE
Other - Last Name:TROMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 CHILDRENS PLZ
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1873
Mailing Address - Country:US
Mailing Address - Phone:855-206-2096
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:501-364-4082
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110727208600000X
OH35.1491662086S0102X, 208600000X
AZ595572086S0102X, 2086S0127X
IAMD-403772086S0127X
IN01081323A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery