Provider Demographics
NPI:1831231802
Name:FONTAINE, MAGALI J (MD PHD)
Entity type:Individual
Prefix:
First Name:MAGALI
Middle Name:J
Last Name:FONTAINE
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Gender:F
Credentials:MD PHD
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Mailing Address - Street 1:22 S GREENE ST
Mailing Address - Street 2:ROOM N2W50A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-3834
Mailing Address - Fax:410-328-0929
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:ROOM N2W50A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3834
Practice Address - Fax:410-328-0929
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD76414207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology