Provider Demographics
NPI:1831493022
Name:DON J. FONTANA, M.D. PA
Entity Type:Organization
Organization Name:DON J. FONTANA, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-870-0600
Mailing Address - Street 1:3500 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3238
Mailing Address - Country:US
Mailing Address - Phone:301-870-0600
Mailing Address - Fax:301-870-0609
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3238
Practice Address - Country:US
Practice Address - Phone:301-870-0600
Practice Address - Fax:301-870-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-01
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023431208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty