Provider Demographics
NPI:1932199650
Name:FONTAINE, DAVID A (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:FONTAINE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:484-526-3990
Mailing Address - Fax:610-868-2915
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 603
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:484-526-3990
Practice Address - Fax:610-868-2915
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA050685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant