Provider Demographics
NPI:1033111315
Name:FONTANA, UMBERTO GAETANO (MD)
Entity Type:Individual
Prefix:DR
First Name:UMBERTO
Middle Name:GAETANO
Last Name:FONTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6725
Mailing Address - Fax:252-413-6268
Practice Address - Street 1:709 N JUSTICE ST STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3455
Practice Address - Country:US
Practice Address - Phone:828-697-7377
Practice Address - Fax:828-697-7380
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400794207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8932909Medicaid
NC32909OtherBCBS
NCNN0286GOtherMEDICARE PTAN
NC8932909Medicaid