Provider Demographics
NPI:1346234788
Name:FONTAINE, ANNETTE C (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:C
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:CAMPBELL
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4901 LANG AVE NE
Mailing Address - Street 2:NEW MEXICO ONCOLOGY & HEMATOLOGY CONSULTANTS, LTD
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4397
Mailing Address - Country:US
Mailing Address - Phone:505-842-8171
Mailing Address - Fax:505-246-0684
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:NEW MEXICO ONCOLOGY & HEMATOLOGY CONSULTANTS, LTD
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4397
Practice Address - Country:US
Practice Address - Phone:505-842-8171
Practice Address - Fax:505-246-0684
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2005-0639207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23481781Medicaid
BC9001772OtherDEA
NM349602309Medicare PIN