Provider Demographics
NPI:1912918830
Name:FONTAINE, CATHERINE SYLVIA (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SYLVIA
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 BENDWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-2704
Mailing Address - Country:US
Mailing Address - Phone:214-693-5466
Mailing Address - Fax:
Practice Address - Street 1:12700 HILLCREST RD
Practice Address - Street 2:SUITE 260
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2071
Practice Address - Country:US
Practice Address - Phone:214-503-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ74852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G8569OtherBCBSTX
TX8G8569OtherBCBSTX BILLING#
TXJ7485OtherLICENSE#
TXG20929Medicare UPIN
TX8G1613Medicare PIN
8B8181Medicare PIN
TXJ7485OtherLICENSE#
TX613442Medicare PIN