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Contact Information

ELLEN FAN M D P A
8240 MANDERVILLE LN
DALLAS, TX75231-1104
 Phone: 972-769-8572
 Fax: 972-769-8591
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Psychiatry

2084P0805X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for ELLEN FAN M D P A · (Female)

NPI # 1467890178
Status Active
Credentials
Entity Individual
Enumeration date 06/05/2013
Last updated 05/29/2025 - More than a year ago
Sole proprietor 1 Not specified
Identifiers
  • TX License # K8897
  • TX Medicaid 179654201
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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