1659464964 NPI number — DOUGLAS R FONTEYNE D.C.

Table of content: DOUGLAS R FONTEYNE D.C. (NPI 1659464964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659464964 NPI number — DOUGLAS R FONTEYNE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTEYNE
Provider First Name:
DOUGLAS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FONTEYNE
Provider Other First Name:
DOUGLAS
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659464964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3756 S AMHERST HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MADISON HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24572-5985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-929-4999
Provider Business Mailing Address Fax Number:
434-929-4997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3756 S. AMHERST HWY
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
MADISON HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24572-5985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-929-4999
Provider Business Practice Location Address Fax Number:
434-929-4997
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104001637 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 263552 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2995862 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 350040203 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".