Healthcare Provider Details

I. General information

NPI: 1346205184
Provider Name (Legal Business Name): DAVID W FONTAINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RIVERWAY PL
BEDFORD NH
03110-6768
US

IV. Provider business mailing address

703 RIVERWAY PL
BEDFORD NH
03110-6745
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-7096
  • Fax: 603-669-6944
Mailing address:
  • Phone: 603-627-1661
  • Fax: 603-669-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number11108
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: