Healthcare Provider Details

I. General information

NPI: 1801263934
Provider Name (Legal Business Name): CHRISTOPHER FUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

101 N WOLFE ST APT 405
BALTIMORE MD
21231-1675
US

V. Phone/Fax

Practice location:
  • Phone: 780-297-2707
  • Fax:
Mailing address:
  • Phone: 780-297-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberD0079201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: