Provider Demographics
NPI:1639669575
Name:FONTAINE-RASAIAH, BEVERLI (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLI
Middle Name:
Last Name:FONTAINE-RASAIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BEVERLI
Other - Middle Name:
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8300 GREENSBORO DR STE L1-121
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3605
Mailing Address - Country:US
Mailing Address - Phone:702-223-4072
Mailing Address - Fax:
Practice Address - Street 1:5550 FRIENDSHIP BLVD STE 360
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7256
Practice Address - Country:US
Practice Address - Phone:240-341-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0085002207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology