Provider Demographics
NPI:1588836126
Name:FUNDAKOWSKI, CHRISTOPHER EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EDWARD
Last Name:FUNDAKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4204
Mailing Address - Country:US
Mailing Address - Phone:215-955-6784
Mailing Address - Fax:215-923-4532
Practice Address - Street 1:925 CHESTNUT ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6784
Practice Address - Fax:215-923-4532
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD49551207Y00000X
PAMD451417207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology