Provider Demographics
NPI:1932505294
Name:FORTIN, DONALD FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:FREDERICK
Last Name:FORTIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14001 WESTON PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2255
Mailing Address - Country:US
Mailing Address - Phone:919-439-3076
Mailing Address - Fax:919-481-0107
Practice Address - Street 1:14001 WESTON PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2255
Practice Address - Country:US
Practice Address - Phone:919-439-3076
Practice Address - Fax:919-481-0107
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33824207RC0000X
TXH0350207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease