Provider Demographics
NPI:1528060258
Name:FAGAN, STEVEN JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:FAGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ANITA DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3603
Mailing Address - Country:US
Mailing Address - Phone:843-200-2815
Mailing Address - Fax:
Practice Address - Street 1:128 ANITA DR
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3603
Practice Address - Country:US
Practice Address - Phone:843-200-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC07032085N0700X
ME10312085N0700X
FLOS 84122085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48180Medicare UPIN