Healthcare Provider Details

I. General information

NPI: 1326305145
Provider Name (Legal Business Name): KATHRYN FONTAINE SCHWEIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN RENEE FONTAINE PA-C

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 OSLER DR SUITE 104
TOWSON MD
21204-7737
US

IV. Provider business mailing address

7505 OSLER DR. SUITE #104
TOWSON MD
21204-7737
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-8888
  • Fax: 410-825-4833
Mailing address:
  • Phone: 410-337-8888
  • Fax: 410-825-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0005089
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC05089
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: