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Contact Information

MARLEY A GRIFFIN FAGG, DO
138 N DIXON RD
KOKOMO, IN46901
 Phone: 765-236-8282
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for MARLEY A GRIFFIN FAGG · (Female)

NPI Number 1811283005
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 06/26/2011
Last updated 06/24/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 02004405A
  • MI License # 5101019418
  • IN Medicaid 201232310
Hospital affiliation(s)
  • COMMUNITY HOWARD REGIONAL HEALTH INC - (Acute Care)
    3500 S LAFOUNTAIN ST
    KOKOMO, IN 46902
  • DUKES MEMORIAL HOSPITAL - (Critical Access)
    275 W 12TH ST
    PERU, IN 46970
  • ST JOSEPH HOSPITAL & HEALTH CENTER INC - (Acute Care)
    1907 W SYCAMORE ST
    KOKOMO, IN 46904
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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