Healthcare Provider Details

I. General information

NPI: 1144809096
Provider Name (Legal Business Name): CHRISTOPHER THOMAS BANACH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SPRUCE ST STE 403
PHILADELPHIA PA
19106-4027
US

IV. Provider business mailing address

700 SPRUCE ST STE 403
PHILADELPHIA PA
19106-4027
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-8420
  • Fax: 215-829-8418
Mailing address:
  • Phone: 215-829-8420
  • Fax: 215-829-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT020556
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS026170
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: