Healthcare Provider Details

I. General information

NPI: 1780376939
Provider Name (Legal Business Name): GIA FRANCESCA FONTANAZZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRIDGE ST STE 201
DANVILLE VA
24541-1222
US

IV. Provider business mailing address

109 BRIDGE ST STE 201
DANVILLE VA
24541-1222
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-4488
  • Fax: 434-773-6977
Mailing address:
  • Phone: 434-799-4488
  • Fax: 434-773-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116038546
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: