Provider Demographics
NPI:1518911627
Name:FONTE, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:FONTE
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 1:20 ERFORD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1163
Mailing Address - Country:US
Mailing Address - Phone:717-761-8332
Mailing Address - Fax:
Practice Address - Street 1:20 ERFORD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1163
Practice Address - Country:US
Practice Address - Phone:717-761-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029087E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007396760004Medicaid
A72691Medicare UPIN
PA121375Medicare ID - Type Unspecified