Provider Demographics
NPI:1629003231
Name:FONTANA, CHRISTY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 MCCOMAS WAY
Mailing Address - Street 2:STE. 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3908
Mailing Address - Country:US
Mailing Address - Phone:757-668-6715
Mailing Address - Fax:757-668-6680
Practice Address - Street 1:2117 MCCOMAS WAY
Practice Address - Street 2:STE. 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3908
Practice Address - Country:US
Practice Address - Phone:757-668-6715
Practice Address - Fax:757-668-6680
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA254588OtherALLIANCE,MDIPA,MAMSI
VA5417787860392EOtherCIGNA
NC790610PMedicaid
VI56838OtherOPTIMA, FAMILY CARE,FAMIS
NC541778786OtherNC HEALTH
VA460098OtherANTHEM BCBS,HK,HK,FAMIS
VA6716911Medicaid
NC790610PMedicaid