Healthcare Provider Details

I. General information

NPI: 1659995678
Provider Name (Legal Business Name): EMILIE CATHERINE FORTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

IV. Provider business mailing address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

V. Phone/Fax

Practice location:
  • Phone: 757-282-4150
  • Fax: 757-510-9455
Mailing address:
  • Phone: 757-282-4150
  • Fax: 757-510-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116034680
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101289803
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: