Provider Demographics
NPI:1962183590
Name:FAGAN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 WASHINGTON ST APT 7
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4599
Mailing Address - Country:US
Mailing Address - Phone:781-640-7441
Mailing Address - Fax:
Practice Address - Street 1:1 CLARKS HL STE 302
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8172
Practice Address - Country:US
Practice Address - Phone:508-589-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program