Provider Demographics
NPI:1255727087
Name:FONTENOT, DANIELLE TAYLOR (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TAYLOR
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:DOW
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1091 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1873
Mailing Address - Country:US
Mailing Address - Phone:828-210-7990
Mailing Address - Fax:828-210-7998
Practice Address - Street 1:1091 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1873
Practice Address - Country:US
Practice Address - Phone:828-210-7990
Practice Address - Fax:828-210-7998
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ607492086S0129X
390200000X
NC2021-023212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program