Healthcare Provider Details

I. General information

NPI: 1760680607
Provider Name (Legal Business Name): JOACHIM MICHAEL FANALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JACK M FANALE MD

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

2115 WISCONSIN AVE NW SUITE 300
WASHINGTON DC
20007-2265
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8232
  • Fax: 202-444-7752
Mailing address:
  • Phone: 202-444-8232
  • Fax: 202-444-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberD0023132
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: