ELLEN FAN M D P A; NPI #1467890178

Contact Information

ELLEN FAN M D P A

8240 MANDERVILLE LN
DALLAS, TX 75231-1104

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

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NPI Profile & details for ELLEN FAN M D P A

NPI # 1467890178

LBN Legal business name ELLEN FAN M D P A

Authorized official ELLEN FAN - (PHYSICIAN)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/05/2013

Last updated 05/29/2025 - More than a year ago

Identifiers

TX	License #	K8897
TX	Medicaid	179654201

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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