Provider Demographics
NPI:1649394685
Name:FAHY, HARVEY
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:FAHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E HYMAN AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1995
Mailing Address - Country:US
Mailing Address - Phone:970-544-1300
Mailing Address - Fax:970-429-8423
Practice Address - Street 1:630 E HYMAN AVE STE 25
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1951
Practice Address - Country:US
Practice Address - Phone:970-544-1300
Practice Address - Fax:970-544-1334
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01295757Medicaid