Healthcare Provider Details

I. General information

NPI: 1710739701
Provider Name (Legal Business Name): ALEXANDRA FOUNTAINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEX FOUNTAINE DO

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W BOWERY ST
AKRON OH
44308-1046
US

IV. Provider business mailing address

7645 WINTERBERRY DR
BOARDMAN OH
44512-4723
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58.034075
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: