Basic Information
| Provider Information | |||||||||
| NPI: | 1598776452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FANALE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 499 E HAMPDEN AVE | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037814485 | ||||||||
| FaxNumber: | 3037887666 | ||||||||
| Practice Location | |||||||||
| Address1: | 499 E HAMPDEN AVE | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037814485 | ||||||||
| FaxNumber: | 3037887666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 036-149224 | IL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 43448 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | COA105217 | 01 | CO | MEMORIAL HOSPITAL UPIN | OTHER | 84123389 | 05 | CO | MEDICAID |