Provider Demographics
NPI:1336840735
Name:FORTUNE, MARTINE
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 MARY THERESA CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1028
Mailing Address - Country:US
Mailing Address - Phone:240-988-3612
Mailing Address - Fax:
Practice Address - Street 1:6311 MARY THERESA CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1028
Practice Address - Country:US
Practice Address - Phone:240-988-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program