Provider Demographics
NPI:1609273440
Name:FONTES, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:FONTES
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 1:1834 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:TAMIMENT
Mailing Address - State:PA
Mailing Address - Zip Code:18371
Mailing Address - Country:US
Mailing Address - Phone:484-788-4462
Mailing Address - Fax:
Practice Address - Street 1:1834 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:TAMIMENT
Practice Address - State:PA
Practice Address - Zip Code:18371
Practice Address - Country:US
Practice Address - Phone:717-569-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03548237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist