Provider Demographics
NPI:1386737997
Name:FAHEY, ANN LEILANI (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:LEILANI
Last Name:FAHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 411
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-3114
Practice Address - Fax:856-541-5379
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62096208200000X
PAMD069186L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2042706OtherCIGNA
NJ24357OtherUNIVERISTY HEALTH PLAN
NJ438669OtherAP BS HIGHMARK
NJCA0000364 01OtherAMERICHOICE
NJP1911543OtherOXFORD
NJ240006442OtherRR MEDICARE
NJ0658970000OtherAMERIHEALTH/KEYSTONE/IBC
NJ1944936OtherUNITED HEALTHCARE
NJ2230968OtherAETNA
NJ3K6089OtherHEALTHNET
NJ438669OtherAMERIHEALTH PPO/IBC/ PA BS
NY8025304OtherNY MEDICAID
NJ1098414OtherHORIZON NJ HEALTH
NJ8025304Medicaid
NY8025304OtherNY MEDICAID
NJP1911543OtherOXFORD