Provider Demographics
NPI:1528230364
Name:FANJOY, CHRISTIAN ARTHUR SR (STNA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:ARTHUR
Last Name:FANJOY
Suffix:SR
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 WICK AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-1509
Mailing Address - Country:US
Mailing Address - Phone:419-496-1385
Mailing Address - Fax:
Practice Address - Street 1:809 WICK AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-1509
Practice Address - Country:US
Practice Address - Phone:419-496-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400694061207172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2788916Medicaid