| Ellen Fan M D P A | |
|
2620 Communications Pkwy Attn Dr. Fan Plano TX 75093-8800 | |
| (972) 769-8572 | |
| (972) 769-8591 |
| Full Name | Ellen Fan M D P A |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2620 Communications Pkwy, Plano, Texas |
| Authorized Official Name and Position | Ellen Fan (PHYSICIAN) |
| Authorized Official Contact | 9727698572 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen Fan M D P A 3308 Preston Rd Suite 350 Box 242 Plano TX 75093-7453 Ph: (972) 769-8572 | Ellen Fan M D P A 2620 Communications Pkwy Attn Dr. Fan Plano TX 75093-8800 Ph: (972) 769-8572 |
| NPI Number | 1982742276 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 02/14/2014 |
| Medicare PECOS PAC ID | 9931140605 |
|---|---|
| Medicare Enrollment ID | O20050512001017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982742276 | NPI | - | NPPES |
| 179654201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | K8897 (Texas) | Primary |
| Provider Name | Ellen Fan |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1134153646 PECOS PAC ID: 5193793487 Enrollment ID: I20050512001030 |
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